We previously reported on a correlation between weight and lymphedema (see Dr. Reid's Corner-Complete Obesity Survey Results and eNews August 2001). New research links effective weight management with a reduction in breast cancer risk (1). We have known for many years that effective weight control can reduce the risk for diabetes, heart disease and blood pressure. But this new data now adds reduced risk of breast cancer to the list of benefits derived from effective weight control. The link between breast cancer and obesity seem to be higher estrogen levels among women with higher body weights. The ovaries produce estrogen. But, at menopause the production of estrogen from the ovaries decreases. Among postmenopausal women, most of the estrogen comes from fat tissue and women who are overweight can have significantly more circulating estrogens than women with normal body weight. Since the risk of breast cancer is associated with estrogen exposure, it was hypothesized that overweight women may be at higher risk for breast cancer. In two separate studies, women who were more than 22 to 55 pounds above their ideal weight were at significantly greater risk of developing breast cancer. The researcher suggests that as much as 15% of breast cancer may be due to obesity. On the positive side, women who reduced their weight by 22 pounds or more during menopause and kept the weight off were less likely to develop breast cancer.

I have been interested in the effects of obesity on lymphedema for many years and we have been conducting an on line survey that seeks to evaluate the physical and emotional effects of lymphedema. We reported the results of this survey at previous meetings of the NLN and at the San Antonio Breast Cancer meeting. The data from our survey suggests that lymphedema is more severe among those with higher body weight and that infections of the skin were much more common among patients with lymphedema who were overweight. In addition, those who were overweight were more likely to have physical limitations that impaired their ability to conduct daily activities. In our survey, it was notable that there was no correlation between weight and the amount of emotional support the patients received from their families and friends and most patients remained optimistic that they could overcome the problems associated with lymphedema.

We continue to collect data on the correlation between lymphedema and obesity and will be updating our findings later this year. Anyone who is interested in contributing to this effort and has not already submitted a response to our survey can do so

Our experiences in treating lymphedema shows that obesity is not only a contributing factor to breast cancer risk, but also contributes to the risk of developing lymphedema. In addition, the severity of lymphedema is correlated with obesity. Our experience also mirrors the results reported for breast cancer risk. We also find that effective control of lymphedema can be more effectively achieved and maintained among the patients who are also able to effectively reduce excess body weight. While obesity is not the only factor contributing to the risk of lymphedema it is an important and potentially controllable factor. Effective weight management coupled with effective treatment may help many patients suffering from the effects of lymphedema.

Tony Reid MD Ph.D

1.Eliassen AH, Colditz GA, Rosner B. et. al. Adult weight change and risk of postmenopausal breast cancer. JAMA 2006; 296: 193-201.
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