In the arms of the angel.

Lymphedema can be a big problem following breast cancer treatment. Luckily, the American Society of Breast Surgeons now provides recommendations for its management. Some good takeaways are that an active surveillance approach is favored over a wait and see approach, as early intervention can reduce severity. Better patient education on risk factors is also important. A second article in last week’s Annals of Surgical Oncology describes a large cohort study of lymphedema. The risk at 5 years was about 10%, which averages the lower (5%) risk with sentinel node biopsy and the higher (15%) risk with full axillary dissection. But don’t shame the surgeons just yet: Patients with the greatest risk (>25%) were those who underwent axillary dissection, nodal radiation, and chemotherapy. So keep a low threshold for active surveillance in a patient receiving comprehensive treatmentand comprehensive riskin order to identify and treat lymphedema early to keep those arms looking angelic.

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