Document Type


Date of Degree

Fall 2010

Degree Name

PhD (Doctor of Philosophy)

Degree In


First Advisor

Dennis, Leslie K

First Committee Member

Lynch, Charles F

Second Committee Member

Snetselaar, Linda G

Third Committee Member

Scott-Conner, Carol

Fourth Committee Member

Zamba, Gideon


Lymphedema of the arm is a complication that occurs in about 10-20% of women treated for breast cancer. Breast cancer treatment can damage or disrupt normal lymphatic pathways, causing fluid to accumulate in the arm. This condition is called lymphedema. Swelling of the arm can be painful and disfiguring, negatively impacting the quality of life of afflicted individuals. Lymphedema is a progressive disorder that requires prompt diagnosis and treatment to prevent the occurrence of more serious complications, such as infection or severe disability of the arm. Past research have attempted to identify risk factors that influenced the development of lymphedema, however conflicting results were observed between studies.

Therefore, a comprehensive literature review was conducted to identify studies that examined the effect of prognostic and/or personal factors on lymphedema. In the meta-analyses, results from each independent study were abstracted and pooled with other studies using the random-effects model. In an effort to examine additional factors that were not widely studied, a retrospective cohort study was conducted on women diagnosed with breast cancer in Iowa during 2004.

A questionnaire was developed to collect information on arm activities, co-morbidity, and lymphedema-related symptoms. Eligible women were identified from the State Health Registry of Iowa and data were collected through computer-assisted telephone interviews. At the end of the interview, each woman was asked to measure the circumference of her right and left arm one hand width above and below the elbow crease.

The meta-analysis found that mastectomy (as opposed to a lumpectomy), axillary dissection (as opposed to sentinel node biopsy), radiation therapy, presence of positive nodes, obesity (body mass index >30), low education (less than high school), presence of any co-morbidity, injury and infection increased the risk of developing lymphedema. The cohort study found that the presence of axillary dissection and radiation, cancer stage, positive nodes, large tumor size, high body mass index, and younger women increased the risk of lymphedema.


Arm Activity, Arm Lymphedema, Body Mass Index, Breast Cancer, Treatment


viii, 153 pages


Includes bibliographical references (pages 140-153).


Copyright 2010 Rebecca Tsai