{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T03:08:43Z","timestamp":1785553723947,"version":"3.56.0"},"reference-count":70,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,2,7]],"date-time":"2020-02-07T00:00:00Z","timestamp":1581033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01 CA092447"],"award-info":[{"award-number":["R01 CA092447"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R21 CA137483"],"award-info":[{"award-number":["R21 CA137483"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Breast cancer\u2013related lymphedema (BCRL) is a well-known side effect of cancer and its treatment with wide-ranging prevalence estimates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This study describes associations between breast cancer\u2013related lymphedema (BCRL) signs, symptoms, and diagnosis for women who were African American, white, or had a low income and survived breast cancer.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>This is a cross-sectional, observational study that used a computer-assisted telephone interview.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Women who had survived breast cancer were queried on the presence of 5 lymphedema signs and symptoms (edema in the breast, axilla, arm, and\/or hand; tissue fibrosis; pitting; hemosiderin staining; heaviness) and whether they had a diagnosis of BCRL. Relationships between signs\/symptoms and diagnosis for each group were evaluated with kappa and chi-square statistics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The study sample included 528 women who had survived breast cancer (266 white and 262 African American), with 514 reporting complete data on household income; 45% of the latter reported an annual household income of \u2264$20,000. Women who were African American or had a low income were nearly twice as likely as women who were white to have any of 8 signs\/symptoms of BCRL. Regardless of race and income, &amp;gt;50% of women with all BCRL signs and symptoms reported that they were not diagnosed with BCRL.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Limitations<\/jats:title>\n                  <jats:p>The main limitations of our study are the lack of medical chart data and longitudinal design.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Women who were African American or had a low income and had survived breast cancer had a greater burden of BCRL signs and symptoms than women who were white. The lack of a strong association between BCRL signs, symptoms, and diagnosis suggests that BCRL may be underdiagnosed. These findings suggest that more rigorous screening and detection of BCRL\u2014especially for women who are African American or have a low income\u2014may be warranted. Cancer rehabilitation programs may be able to fill this gap.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzaa002","type":"journal-article","created":{"date-parts":[[2020,1,11]],"date-time":"2020-01-11T12:11:13Z","timestamp":1578744673000},"page":"487-499","source":"Crossref","is-referenced-by-count":27,"title":["Lymphedema Signs, Symptoms, and Diagnosis in Women Who Are in Minority and Low-Income Groups and Have Survived Breast Cancer"],"prefix":"10.1093","volume":"100","author":[{"given":"Ann Marie","family":"Flores","sequence":"first","affiliation":[{"name":"Departments of Physical Therapy and Human Movement Sciences and Medical Social Sciences , Northwestern University, Chicago, Illinois; Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611 (USA)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Nelson","sequence":"additional","affiliation":[{"name":"Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Tufts University Medical Center , Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee","family":"Sowles","sequence":"additional","affiliation":[{"name":"OmKids , Portland, Maine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca G","family":"Stephenson","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Services, Brigham and Women's Hospital , Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Robinson","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Maine , Orono, Maine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Cheville","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Mayo Clinic , Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoinette P","family":"Sander","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Human Movement Sciences and Medical Social Sciences , Northwestern University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J","family":"Blot","sequence":"additional","affiliation":[{"name":"International Epidemiology Institute, Rockville, Maryland; and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center , Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,2,7]]},"reference":[{"key":"2023011707264728200_ref1","doi-asserted-by":"crossref","first-page":"220","DOI":"10.3322\/caac.21149","article-title":"Ca ncer treatment and survivorship statistics, 2012","volume":"62","author":"Siegel","year":"2012","journal-title":"CA Cancer J Clin."},{"key":"2023011707264728200_ref2","volume-title":"Novel Strategies in Lymphedema","author":"Radina","year":"2012"},{"key":"2023011707264728200_ref3","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s10549-007-9710-9","article-title":"Prognosis of the upper limb following surgery and radiation for breast cancer","volume":"110","author":"Lee","year":"2008","journal-title":"Breast Cancer Res Treat."},{"key":"2023011707264728200_ref4","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.breast.2010.05.015","article-title":"Self-reported arm-lymphedema and functional impairment after breast cancer treatment: a nationwide study of prevalence and associated factors","volume":"19","author":"Gartner","year":"2010","journal-title":"Breast."},{"key":"2023011707264728200_ref5","doi-asserted-by":"crossref","first-page":"807569","DOI":"10.1155\/2013\/807569","article-title":"Comparison of breast cancer-related lymphedema (upper limb swelling) prevalence estimated using objective and subjective criteria and relationship with quality of life","volume":"2013","author":"Bulley","year":"2013","journal-title":"Biomed Res Int."},{"key":"2023011707264728200_ref6","first-page":"73","article-title":"Lymphedema following breast cancer treatment, including sentinel lymph node biopsy","volume":"37","author":"Armer","year":"2004","journal-title":"Lymphology."},{"key":"2023011707264728200_ref7","doi-asserted-by":"crossref","first-page":"5220","DOI":"10.1200\/JCO.2008.16.3766","article-title":"Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors","volume":"26","author":"McLaughlin","year":"2008","journal-title":"J Clin Oncol."},{"key":"2023011707264728200_ref8","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.ejso.2011.09.001","article-title":"Prevalence of lymphoedema more than five years after breast cancer treatment","volume":"37","author":"Lopez Penha","year":"2011","journal-title":"Eur J Surg Oncol."},{"key":"2023011707264728200_ref9","doi-asserted-by":"crossref","first-page":"e60164","DOI":"10.1371\/journal.pone.0060164","article-title":"Lymphatic and angiogenic candidate genes predict the development of secondary lymphedema following breast cancer surgery","volume":"8","author":"Miaskowski","year":"2013","journal-title":"PLoS One."},{"key":"2023011707264728200_ref10","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1007\/s00520-018-4334-7","article-title":"Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons oncology group (ACOSOG) Z1071 (Alliance) substudy","volume":"27","author":"Armer","year":"2019","journal-title":"Support Care Cancer."},{"key":"2023011707264728200_ref11","first-page":"224","volume-title":"F\u00f6ldi's Textbook of Lymphology for Physicians and Lymphedema Therapists","author":"F\u00f6ldi","year":"2006","edition":"2nd"},{"key":"2023011707264728200_ref12","author":"Medical Advisory Committee"},{"key":"2023011707264728200_ref13","first-page":"170","article-title":"The diagnosis and treatment of peripheral lymphedema: 2016 consensus document of the International Society of Lymphology","volume":"49","author":"Committee","year":"2016","journal-title":"Lymphology."},{"key":"2023011707264728200_ref14","first-page":"2018","article-title":"National Lymphedema Network. 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