Women are fearful of developing lymphoedema following treatment for breast cancer.  What advice women are provided with and what strategies they make take to prevent lymphoedema has not progressed significantly over the past 20 years.   The focus of many studies of risk factor has been on variables extracted from the medical records as well as lifestyle factors.  While there have been many studies, for the most part, there has been little new information presented: axillary node dissection and radiotherapy to the axilla are consistently identified as risk factors for lymphoedema.  Other factors such as obesity are identified in some studies but not others.  Provision of additional clear evidence-based messages to women treated for breast cancer has been hampered by lack of evidence-based criteria for detection of lymphoedema, lack of differentiation of transient swelling commonly experienced in the first year with lymphoedema,  and lack of prospective studies to determine risk factors beyond medical and lifestyle factors.  To address these issues, we compared a range of clinical measures to a reference standard to identify evidence-based criteria diagnosis of lymphoedema.  The other issues were addressed in a cohort study that followed women from before surgery to 18 m following surgery: i) swelling identified in the first year was used as a risk factor for swelling at 18 months; and ii) women completed weekly diaries to identify if they experienced arm trauma, air travel, and significant environmental changes. Data were analysed separately for women who had <5 nodes removed from those who had ≥ 5 nodes removed.  This approach led to us to conclude that advice to women should be dependent on number of nodes removed, and for both, we should not be burdening them with range of behaviors to avoid. Importantly, for women at high risk, periodic assessment in the first year should occur to identify and manage any arm swelling.

 Acknowledgement: Cancer Australia and NBCF