In the Halstedian era (1920-1970s), women with breast cancer were treated with mastectomy and full axillary dissection, usually without radiotherapy or chemotherapy. Thus, the lymphedema of the arm that occurred during this period was primarily and appropriately blamed on the surgeon. In the current non-Halstedian era of multimodality therapy, lymphedema can be blamed on everyone.
In the study by Armer et al1 on lymphedema in women treated in the American College of Surgeons Oncology Group Z1071 (Alliance for Clinical Trials in Oncology) trial with neoadjuvant chemotherapy (NAC), 58% of women had lymphedema according to volumetric measurements or a validated questionnaire. The high rate is hardly surprising because all women underwent axillary dissection, 87% received postoperative radiotherapy, and 46% had a body mass index (calculated as weight in kilograms divided by height in meters squared) higher than 30 (ie, had clinical obesity2).
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Vetto JT. Lymphedema After Breast Cancer Treatment—Not Just the Surgeon’s Fault. JAMA Surg. Published online July 17, 2019154(9):810. doi:10.1001/jamasurg.2019.1743
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