Blayney said that although current surgical treatment is attempting to move away from disturbing the axilla, more women, especially younger women, are choosing mastectomy over breast conserving surgery. Mastectomy has a higher incidence of swelling and limited shoulder motion. There is a trend now toward increasing use of radiation therapy to the axilla and this approach also might increase the risk of swelling, he said.

"Combined, these trends in primary treatment of breast cancer make this review highly relevant," said Blayney, who has no affiliation with the review. Nevertheless, he noted that making suitable exercise programs widely available to breast cancer patients in a timely manner would be a challenge.

He said optimal breast cancer care now involves a team with a wide range of health specialists: surgeons, radiation oncologists, medical oncologists, reconstructive surgeons and others. "This review demonstrates that early involvement of a new team member who manages exercise or physical therapy is also useful for the best outcome," he said.

Blayney added that he finds few things as disheartening as seeing a breast cancer survivor in long-term follow-up who is cured yet burdened with a "frozen" shoulder or daily use of a lymphedema sleeve, an elastic compression garment worn over the arm to help move fluid and reduce swelling.

"Implementation of modern primary treatment strategies ??” - including early intervention with suitable exercises ??” should reduce the incidence of these heartbreaking complications," Blayney said.

SOURCE The Cochrane Library

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