Abstract
Background Lymphedema affects up to 34% of patients after breast cancer treatment but remains
underdiagnosed and undertreated. Here, we use area deprivation index (ADI), a measure
of neighborhood socioeconomic disadvantage, to determine how socioeconomic status
may affect risk for and diagnosis of breast cancer-related lymphedema.
Methods Records of patients who underwent surgical treatment of breast cancer between 2017–2020
were examined. Patients' nine-digit ZIP codes were utilized to determine their deprivation
level as a national ADI percentile, and those fitting into the most and least deprived
quartiles were compared with evaluate lymphedema risk factors and incidence.
Results A total of 1,333 breast cancer patients were included, 812 (61%) of whom resided
within the most disadvantaged ADI quartile nationally, and 521 within the least disadvantaged
quartile. The most deprived group had higher rates of diabetes, obesity, and regional
breast cancer, and received more extensive surgeries (7.5% modified radical mastectomy
vs 1.9%, p < 0.001) and chemotherapy compared with the least disadvantaged quartile. The most
disadvantaged cohort were more often at extreme risk of lymphedema utilizing the Risk
Assessment Tool Evaluating Lymphedema Risk (9.1% versus 2.5%, p < 0.001); however, the incidence of lymphedema diagnoses was not significantly higher
(13% vs 12%, p > 0.9). Logistic regression showed that the most deprived ADI quartile
had 44% lower odds of a lymphedema diagnosis in comparison to the least deprived quartile.
Conclusion Residing in more socioeconomically disadvantaged neighborhoods is associated with
lower odds of a lymphedema diagnosis, despite higher rates of risk factors for lymphedema,
suggesting significant underdiagnosis in this population.
Keywords
lymphedema - social determinants of health - breast cancer - mastectomy - breast reconstruction
- breast cancer-related lymphedema
