title: Trends in risk reduction practices for the prevention of lymphedema in the first 12 months after breast cancer surgery.
abstract: BACKGROUND
  Lymphedema is a feared complication of breast cancer surgery. We evaluated the trends in lymphedema development, patient worry, and risk reduction behaviors.
  
  
  METHODS
  We prospectively enrolled 120 women undergoing sentinel node biopsy (SLNB) or axillary node dissection (ALND) for breast cancer and assessed lymphedema by upper extremity volume preoperatively and at 6 and 12 months postoperatively. We defined lymphedema as a >10% volume change from baseline relative to the contralateral upper extremity. Patients completed a validated instrument evaluating lymphedema worry and risk reducing behaviors. Associations were determined by Fisher's exact and signed rank tests.
  
  
  RESULTS
  At 6 months, lymphedema was similar between ALND and SLNB patients (p = 0.22), but was higher in ALND women at 12 months (19% vs 3%, p = 0.005). A clear relationship exists between relative change in upper extremity volume at 6 and 12 months (Kendall tau coefficient 0.504, p < 0.001). Among the women with 0 to 9% volume change at 6 months, 22% had progressive swelling, and 18% resolved their volume changes at 12 months. Overall, 75% of ALND and 50% of SLNB patients had persistent worry about lymphedema at follow-up, and no difference existed in the number of risk reducing behaviors practiced among the 2 groups (p > 0.34).
  
  
  CONCLUSIONS
  Upper extremity volumes fluctuate, and there is a period of latency before development of lymphedema. Despite the low risk of lymphedema after SLNB, most women worry about lymphedema and practice risk reducing behaviors. Additional study into early upper extremity volume changes is warranted to allay the fears of most women and better predict which women will progress to lymphedema.
authors.affiliation: Department of General Surgery, Mayo Clinic, Jacksonville, FL 32224, USA. McLaughlin.Sarah@mayo.edu
authors.forename: Sarah A
authors.initials: SA
authors.lastname: McLaughlin
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bagaria
authors.forename: Tammeza
authors.initials: T
authors.lastname: Gibson
authors.forename: Michelle
authors.initials: M
authors.lastname: Arnold
authors.forename: Nancy
authors.initials: N
authors.lastname: Diehl
authors.forename: Julia
authors.initials: J
authors.lastname: Crook
authors.forename: Alexander
authors.initials: A
authors.lastname: Parker
authors.forename: Justin
authors.initials: J
authors.lastname: Nguyen
mesh_terms: D000368:Aged; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008209:Lymphedema / Q000453:epidemiology / Q000517:prevention & control*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D021701:Sentinel Lymph Node Biopsy