Thursday, October 20, 2011 New in the Literature: Breast Cancer-related Lymphedema (BMJ. 2011 Sep 1 [Epub ahead of print]) Manual lymph drainage in addition to guidelines and exercise therapy after axillary lymph node dissection for breast cancer is unlikely to have a medium to large effect in reducing the incidence of arm lymphedema in the short term as compared with guidelines and exercise therapy only, say authors of an article published online in BMJ. Researchers randomized 160 consecutive patients with breast cancer and unilateral axillary lymph node dissection at the University Hospitals Leuven, Leuven, Belgium, for body mass index and axillary irradiation. Treatment allocation was concealed. Randomization was done independently from recruitment and treatment. Baseline characteristics were comparable between the groups. For 6 months the intervention group (n=79) performed a treatment program consisting of guidelines about the prevention of lymphedema, exercise therapy, and manual lymph drainage. The control group (n=81) performed the same program without manual lymph drainage. Cumulative incidence of arm lymphedema and time to develop arm lymphedema, defined as an increase in arm volume of 200 ml or more in the value before surgery. Four patients in the intervention group and 2 in the control group were lost to follow-up. At 12 months after surgery, the cumulative incidence rate for arm lymphedema was comparable between the intervention group (24%) and control group (19%) (odds ratio 1.3). The time to develop arm lymphedema was comparable between the 2 groups during the first year after surgery (hazard ratio 1.3, 0.6 to 2.5).