Up in arms.

Top Line: There have been decades of trials working to de-escalate standard surgical axillary management for clinically node-negative breast cancer.
The Study: Why all the fuss? In a (dreaded) word, lymphedema. Women are understandably terrified of this morbid complication from a treatment of a cancer that has diminishing risk of limiting their lives. This prospective observational study spanning 12 years and over 1200 women treated for breast cancer at MGH aims to arm you with the risk components for all your risk/benefit calculations. Lymphedema rates at 5 years following full axillary dissection with and without regional nodal irradiation were 31% and 25%, respectively, and following sentinel node dissection were 12% and 8%. Rather intuitively, timing of peak onset of lymphedema varied with treatment modality ranging from 0.5-1 year following axillary dissection to 3-4 years following regional nodal radiation. What’s the single biggest risk factor at play that's out of the oncologists’ hands? Body habitus. BMI ≥30 carried a hazard ratio equal to that of receiving regional nodal radiation.
Bottom Line: For the increasing number of women undergoing sentinel node dissection alone, the risk of lymphedema at 5 years is a fraction of that seen with full axillary dissection but remains relatively impacted by radiation and body habitus. | McDuff, Int J Radiat Oncol Biol Phys


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