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).
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Vetto JT. Lymphedema After Breast Cancer Treatment—Not Just the Surgeon’s Fault. JAMA Surg. 2019;154(9):810. doi:https://doi.org/10.1001/jamasurg.2019.1743
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: