Breast Oncology Published: 19 September 2023 Volume 31 , pages 284–302 ( 2024 ) Cite this article Identification of risk factors facilitates the prevention of breast cancer-related lymphedema (BCRL). Several published systematic reviews have already addressed the risk factors for BCRL. This study aimed to systematically identify potential risk factors for BCRL and evaluate the quality of evidence. The study followed methodologic guidance from the Joanna Briggs Institute, and the Cochrane Handbook. The following electronic databases were systematically searched from inception to 15 November 2022: PubMed, Embase, CINAHL, Web of Science, Scopus, CNKI, SinoMed, Wanfang, JBI Database, Cochrane Database, ProQuest, and PROSPERO. Two authors independently screened studies, extracted data, and assessed methodologic quality using AMSTAR2, risk of bias using ROBIS, and evidence quality using GRADE. The study evaluated overlap, assessed the small-study effect, and calculated the I 2 statistic and Egger’s P value as needed. The study included 14 publications comprising 10 meta-analyses and 4 systematic reviews. The authors identified 39 factors and 30 unique meta-analyses. In the study, 13 innate personal trait-related risk factors, such as higher body mass index (BMI) and axillary lymph nodes dissection, showed statistically significant associations with BCRL incidence. Breast reconstruction was found to be a protective factor. The methodologic quality was low or critically low. The majority of the systematic reviews and/or meta-analyses were rated as having a high risk of bias. Evidence quality was low for 22 associations and moderate for 8 associations. The currently identified risk factors for BCRL all are innate personal trait-related factors. Future well-designed studies and robust meta-analyses are needed to explore potential associations between behavioral-, interpersonal-, and environmental-related factors and BCRL, as well as the role of genetic variations and pathophysiologic factors. This is a preview of subscription content, log in via an institution to check access. Access this article Subscribe and save Starting from 10 chapters or articles per month Access and download chapters and articles from more than 300k books and 2,500 journals Price includes VAT (Hong Kong/P.R.China) Instant access to the full article PDF. Institutional subscriptions Similar content being viewed by others Breast Cancer-Related Lymphedema Risk Factors and Precautionary Behaviors Diagnostic Methods, Risk Factors, Prevention, and Management of Breast Cancer-Related Lymphedema: Past, Present, and Future Directions Risk Factors for Breast Cancer-Related Lymphedema, Risk Reduction, and Myths about Precautionary Behaviors Explore related subjects Cancer Prevention Disease prevention Genetic predisposition to disease Lymphedema Management in Cancer Survivorship Shen A, Lu Q, Fu X, et al. Risk factors of unilateral breast cancer-related lymphedema: an updated systematic review and meta-analysis of 84 cohort studies. Support Care Cancer . 2022;31:18. Article PubMed Google Scholar Shen A, Lu Q, Fu X, et al. Risk factors of unilateral breast cancer-related lymphedema: an updated systematic review and meta-analysis of 84 cohort studies. Support Care Cancer . 2022;31:18. Article PubMed Google Scholar Pappalardo M, Starnoni M, Franceschini G, Baccarani A, De Santis G. Breast cancer-related lymphedema: recent updates on diagnosis, severity, and available treatments. J Pers Med . 2021;11:402. Article PubMed PubMed Central Google Scholar Pappalardo M, Starnoni M, Franceschini G, Baccarani A, De Santis G. Breast cancer-related lymphedema: recent updates on diagnosis, severity, and available treatments. J Pers Med . 2021;11:402. Article PubMed PubMed Central Google Scholar McLaughlin SA, Brunelle CL, Taghian A. Breast cancer-related lymphedema: risk factors, screening, management, and the impact of locoregional treatment. J Clin Oncol . 2020;38:2341–50. Article PubMed PubMed Central Google Scholar McLaughlin SA, Brunelle CL, Taghian A. Breast cancer-related lymphedema: risk factors, screening, management, and the impact of locoregional treatment. J Clin Oncol . 2020;38:2341–50. Article PubMed PubMed Central Google Scholar Rockson SG. Lymphedema after breast cancer treatment. N Engl J Med . 2019;380:694. Article PubMed Google Scholar Rockson SG. Lymphedema after breast cancer treatment. N Engl J Med . 2019;380:694. Article PubMed Google Scholar Tandra P, Kallam A, Krishnamurthy J. Identification and management of lymphedema in patients with breast cancer. J Oncol Pract . 2019;15:255–62. Article PubMed Google Scholar Tandra P, Kallam A, Krishnamurthy J. Identification and management of lymphedema in patients with breast cancer. J Oncol Pract . 2019;15:255–62. Article PubMed Google Scholar Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg . 2018;7:379–403. Article PubMed PubMed Central Google Scholar Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg . 2018;7:379–403. Article PubMed PubMed Central Google Scholar Offord DR, Kraemer HC. Risk factors and prevention. Evid Based Ment Health . 2000;3:70–1. Article Google Scholar Offord DR, Kraemer HC. Risk factors and prevention. Evid Based Ment Health . 2000;3:70–1. Article Google Scholar He L, Qu H, Wu Q, Song Y. Lymphedema in survivors of breast cancer. Oncol Lett . 2020;19:2085–96. PubMed PubMed Central Google Scholar He L, Qu H, Wu Q, Song Y. Lymphedema in survivors of breast cancer. Oncol Lett . 2020;19:2085–96. PubMed PubMed Central Google Scholar Brown S, Dayan JH, Kataru RP, Mehrara BJ. The vicious circle of stasis, inflammation, and fibrosis in lymphedema. Plast Reconstr Surg . 2023;151:330e-e341. Article CAS PubMed Google Scholar Brown S, Dayan JH, Kataru RP, Mehrara BJ. The vicious circle of stasis, inflammation, and fibrosis in lymphedema. Plast Reconstr Surg . 2023;151:330e-e341. Article CAS PubMed Google Scholar Kapellas N, Demiri E, Lampropoulos A, Dionyssiou D. Genetic predisposition in cancer-related lymphedema: a systematic review. Lymph Res Biol . 2022;20:478–87. CAS Google Scholar Kapellas N, Demiri E, Lampropoulos A, Dionyssiou D. Genetic predisposition in cancer-related lymphedema: a systematic review. Lymph Res Biol . 2022;20:478–87. CAS Google Scholar Zhu YQ, Xie YH, Liu FH, et al. Systemic analysis on risk factors for breast cancer-related lymphedema. APJCP Asian Pac J Cancer Prev . 2014;15:6535–41. Article PubMed Google Scholar Zhu YQ, Xie YH, Liu FH, et al. Systemic analysis on risk factors for breast cancer-related lymphedema. APJCP Asian Pac J Cancer Prev . 2014;15:6535–41. Article PubMed Google Scholar Lin Y, Xu Y, Wang C, et al. Loco-regional therapy and the risk of breast cancer-related lymphedema: a systematic review and meta-analysis. Breast Cancer . 2021;28:1261–72. Article CAS PubMed Google Scholar Lin Y, Xu Y, Wang C, et al. Loco-regional therapy and the risk of breast cancer-related lymphedema: a systematic review and meta-analysis. Breast Cancer . 2021;28:1261–72. Article CAS PubMed Google Scholar Guliyeva G, Huayllani MT, Boczar D, et al. Age as a risk factor for breast cancer-related lymphedema: a systematic review. J Cancer Surviv . 2021;17(1):246. Article PubMed Google Scholar Guliyeva G, Huayllani MT, Boczar D, et al. Age as a risk factor for breast cancer-related lymphedema: a systematic review. J Cancer Surviv . 2021;17(1):246. Article PubMed Google Scholar Guliyeva G, Huayllani MT, Boczar D, Avila FR, Forte AJ. Correlation of older age with severity of lymphedema in breast cancer survivors: a systematic review. Breast Dis . 2021;40:191–7. Article CAS PubMed Google Scholar Guliyeva G, Huayllani MT, Boczar D, Avila FR, Forte AJ. Correlation of older age with severity of lymphedema in breast cancer survivors: a systematic review. Breast Dis . 2021;40:191–7. Article CAS PubMed Google Scholar Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ . 2009;339:b2535. Article PubMed PubMed Central Google Scholar Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ . 2009;339:b2535. Article PubMed PubMed Central Google Scholar Aromataris E, Munn Z. JBI Manual for Evidence Synthesis. JBI; 2020. Google Scholar Aromataris E, Munn Z. JBI Manual for Evidence Synthesis. JBI; 2020. Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions. 2nd Ed. Chichester, UK: John Wiley & Sons; 2019. Book Google Scholar Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions. 2nd Ed. Chichester, UK: John Wiley & Sons; 2019. Book Google Scholar Aromataris E, Fernandez R, Godfrey CM, et al. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc . 2015;13:132–40. Article PubMed Google Scholar Aromataris E, Fernandez R, Godfrey CM, et al. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc . 2015;13:132–40. Article PubMed Google Scholar Shen A, Lu Q, Zhang L, et al. Risk factors of breast cancer-related lymphoedema: protocol of an umbrella review. BMJ Open . 2023;13:e070907. Article PubMed PubMed Central Google Scholar Shen A, Lu Q, Zhang L, et al. Risk factors of breast cancer-related lymphoedema: protocol of an umbrella review. BMJ Open . 2023;13:e070907. Article PubMed PubMed Central Google Scholar Morgan RL, Whaley P, Thayer KA, Schunemann HJ. Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int . 2018;121(Pt 1):1027–31. Article PubMed PubMed Central Google Scholar Morgan RL, Whaley P, Thayer KA, Schunemann HJ. Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int . 2018;121(Pt 1):1027–31. Article PubMed PubMed Central Google Scholar Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ . 2017;358:j4008. Article PubMed PubMed Central Google Scholar Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ . 2017;358:j4008. Article PubMed PubMed Central Google Scholar Whiting P, Savovic J, Higgins JP, et al. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol . 2016;69:225–34. Article PubMed PubMed Central Google Scholar Whiting P, Savovic J, Higgins JP, et al. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol . 2016;69:225–34. Article PubMed PubMed Central Google Scholar Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol . 2011;64:401–6. Article PubMed Google Scholar Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol . 2011;64:401–6. Article PubMed Google Scholar Pieper D, Antoine SL, Mathes T, Neugebauer EA, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol . 2014;67:368–75. Article PubMed Google Scholar Pieper D, Antoine SL, Mathes T, Neugebauer EA, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol . 2014;67:368–75. Article PubMed Google Scholar Belbasis L, Bellou V, Evangelou E, Ioannidis JP, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol . 2015;14:263–73. Article PubMed Google Scholar Belbasis L, Bellou V, Evangelou E, Ioannidis JP, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol . 2015;14:263–73. Article PubMed Google Scholar Che Bakri NA, Kwasnicki RM, Khan N, et al. Impact of axillary lymph node dissection and sentinel lymph node biopsy on upper limb morbidity in breast cancer patients: a systematic review and meta-analysis. Ann Surg . 2022;277:572. Article PubMed Google Scholar Che Bakri NA, Kwasnicki RM, Khan N, et al. Impact of axillary lymph node dissection and sentinel lymph node biopsy on upper limb morbidity in breast cancer patients: a systematic review and meta-analysis. Ann Surg . 2022;277:572. Article PubMed Google Scholar

Disipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol . 2013;14:1077–4114 ( (print)(6): 500–515 ). Article Google Scholar Disipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol . 2013;14:1077–4114 ( (print)(6): 500–515 ). Article Google Scholar Kanda MH, da Costa Vieira RA, Lima JPSN, Paiva CE, Cunha de Araujo RL. Late locoregional complications associated with adjuvant radiotherapy in the treatment of breast cancer: systematic review and meta-analysis. J Surg Oncol . 2020;121:766–76. Article PubMed Google Scholar Kanda MH, da Costa Vieira RA, Lima JPSN, Paiva CE, Cunha de Araujo RL. Late locoregional complications associated with adjuvant radiotherapy in the treatment of breast cancer: systematic review and meta-analysis. J Surg Oncol . 2020;121:766–76. Article PubMed Google Scholar Manirakiza A, Irakoze L, Shui L, Manirakiza S, Ngendahayo L. Lymphoedema after breast cancer treatment is associated with higher body mass index: a systematic review and meta-analysis. East Afr Health Res J . 2019;3:178–92. Article PubMed PubMed Central Google Scholar Manirakiza A, Irakoze L, Shui L, Manirakiza S, Ngendahayo L. Lymphoedema after breast cancer treatment is associated with higher body mass index: a systematic review and meta-analysis. East Afr Health Res J . 2019;3:178–92. Article PubMed PubMed Central Google Scholar Siotos C, Sebai ME, Wan EL, et al. Breast reconstruction and risk of arm lymphedema development: a meta-analysis. J Plast Reconstr Aesth Surg . 2018;71:807–18. Article Google Scholar Siotos C, Sebai ME, Wan EL, et al. Breast reconstruction and risk of arm lymphedema development: a meta-analysis. J Plast Reconstr Aesth Surg . 2018;71:807–18. Article Google Scholar Torgbenu E, Luckett T, Buhagiar MA, Chang S, Phillips JL. Prevalence and incidence of cancer-related lymphedema in low and middle-income countries: a systematic review and meta-analysis. BMC Cancer . 2020;20:1–20. Article Google Scholar Torgbenu E, Luckett T, Buhagiar MA, Chang S, Phillips JL. Prevalence and incidence of cancer-related lymphedema in low and middle-income countries: a systematic review and meta-analysis. BMC Cancer . 2020;20:1–20. Article Google Scholar Visser J, van Geel M, Cornelissen AJM, van der Hulst RRWJ, Qiu SS. Breast cancer-related lymphedema and genetic predisposition: a systematic review of the literature. Lymph Res Biol . 2019;17:288–93. Article Google Scholar Visser J, van Geel M, Cornelissen AJM, van der Hulst RRWJ, Qiu SS. Breast cancer-related lymphedema and genetic predisposition: a systematic review of the literature. Lymph Res Biol . 2019;17:288–93. Article Google Scholar Wu R, Huang X, Dong X, Zhang H, Zhuang L. Obese patients have higher risk of breast cancer-related lymphedema than overweight patients after breast cancer: a meta-analysis. Ann Translat Med . 2019;7:172. Article Google Scholar Wu R, Huang X, Dong X, Zhang H, Zhuang L. Obese patients have higher risk of breast cancer-related lymphedema than overweight patients after breast cancer: a meta-analysis. Ann Translat Med . 2019;7:172. Article Google Scholar Chen C, Gu W, Chen Y, et al. Risk factors for postoperative breast cancer-related lymphedema: a meta-analysis. Chin Evid Based Nurs . 2021;7:866–74. Google Scholar Chen C, Gu W, Chen Y, et al. Risk factors for postoperative breast cancer-related lymphedema: a meta-analysis. Chin Evid Based Nurs . 2021;7:866–74. Zhang H, Liu R, Zhu L, et al. Risk factors for breast cancer-related lymphedema in Chinese women: a meta-analysis. Chin Gen Pract . 2021;24:3349–58, 3376. Zhang H, Liu R, Zhu L, et al. Risk factors for breast cancer-related lymphedema in Chinese women: a meta-analysis. Chin Gen Pract . 2021;24:3349–58, 3376. Bronfenbrenner U. Toward an experimental ecology of human development. Am Psychol . 1997;32:513. Article Google Scholar Bronfenbrenner U. Toward an experimental ecology of human development. Am Psychol . 1997;32:513. Article Google Scholar Kennedy W, Fruin R, Lue A, Logan SW. Using ecological models of health behavior to promote health care access and physical activity engagement for persons with disabilities. J Patient Exp . 2021;8:23743735211034030. PubMed PubMed Central Google Scholar Kennedy W, Fruin R, Lue A, Logan SW. Using ecological models of health behavior to promote health care access and physical activity engagement for persons with disabilities. J Patient Exp . 2021;8:23743735211034030. PubMed PubMed Central Google Scholar Schmitz KH, Troxel AB, Dean LT, et al. Effect of home-based exercise and weight loss programs on breast cancer-related lymphedema outcomes among overweight breast cancer survivors: the WISER survivor randomized clinical trial. JAMA Oncol . 2019;5:1605–13. Article PubMed PubMed Central Google Scholar Schmitz KH, Troxel AB, Dean LT, et al. Effect of home-based exercise and weight loss programs on breast cancer-related lymphedema outcomes among overweight breast cancer survivors: the WISER survivor randomized clinical trial. JAMA Oncol . 2019;5:1605–13. Article PubMed PubMed Central Google Scholar Perry R, Whitmarsh A, Leach V, Davies P. A comparison of two assessment tools used in overviews of systematic reviews: ROBIS versus AMSTAR-2. Syst Rev . 2021;10:273. Article CAS PubMed PubMed Central Google Scholar Perry R, Whitmarsh A, Leach V, Davies P. A comparison of two assessment tools used in overviews of systematic reviews: ROBIS versus AMSTAR-2. Syst Rev . 2021;10:273. Article CAS PubMed PubMed Central Google Scholar Download references Acknowledgments This umbrella review was supported by the National Natural Science Foundation of China (72174011). Author information Authors and Affiliations Department of Nursing, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China Aomei Shen MS, Wanmin Qiang BS, Liyuan Zhang BS & Jingru Bian BS Department of Nursing, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China Aomei Shen MS, Wanmin Qiang BS, Liyuan Zhang BS & Jingru Bian BS Division of Medical and Surgical Nursing, School of Nursing, Peking University, Beijing, China Aomei Shen MS, Zijuan Zhang BS & Qian Lu PhD Division of Medical and Surgical Nursing, School of Nursing, Peking University, Beijing, China Aomei Shen MS, Zijuan Zhang BS & Qian Lu PhD Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China Aomei Shen MS, Zijuan Zhang BS & Qian Lu PhD Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China Aomei Shen MS, Zijuan Zhang BS & Qian Lu PhD School of Nursing, Hebei University, Baoding, China Fei Zhu MS School of Nursing, Hebei University, Baoding, China Aomei Shen MS View author publications Search author on: PubMed Google Scholar Search author on: PubMed Google Scholar Wanmin Qiang BS View author publications Search author on: PubMed Google Scholar Search author on: PubMed Google Scholar Liyuan Zhang BS View author publications Search author on: PubMed Google Scholar Search author on: PubMed Google Scholar Jingru Bian BS View author publications Search author on: PubMed Google Scholar Search author on: PubMed Google Scholar Fei Zhu MS View author publications Search author on: PubMed Google Scholar Search author on: PubMed Google Scholar Zijuan Zhang BS View author publications Search author on: PubMed Google Scholar Search author on: PubMed Google Scholar Qian Lu PhD View author publications Search author on: PubMed Google Scholar Search author on: PubMed Google Scholar Corresponding author Correspondence to Qian Lu PhD . 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Ann Surg Oncol 31 , 284–302 (2024). https://doi.org/10.1245/s10434-023-14277-7 Download citation Received : 03 May 2023 Received : 03 May 2023 Accepted : 25 August 2023 Accepted : 25 August 2023 Published : 19 September 2023 Published : 19 September 2023 Version of record : 19 September 2023 Version of record : 19 September 2023 Issue date : January 2024 Issue date : January 2024 DOI : https://doi.org/10.1245/s10434-023-14277-7 DOI : https://doi.org/10.1245/s10434-023-14277-7 Share this article Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative Breast neoplasm Umbrella review Qian Lu View author profile