Replace blanket arm prohibitions after breast cancer with advice that matches the evidence

The evidence. An evidence map prepared for the 2023 American Cancer Society and Lymphology Association of North America Lymphedema Summit searched Medline, CINAHL and Cochrane from 2008 to March 2023 for trauma, blood pressure measurement, skin puncture, temperature, air travel and behaviour change, and included 37 studies. It concluded that a 'just in case' approach to patient education may not be appropriate for people at risk of developing lymphoedema and that evidence is sufficient to refute many of the previously claimed risk factors, while evidence on progression once lymphoedema exists is scant. Cellulitis is described as an established risk factor.

The consensus. The summit's expert panel published updated risk-reduction recommendations covering prospective surveillance, education, exercise, blood pressure, skin care, skin puncture and blood draws, surgery, prophylactic compression, air travel and heat; OnCo read its abstract only. The APTA 2020 guideline already grades supervised progressive resistance training as safe (Grade A), reversing older advice to avoid lifting.

What is not known. No randomised trial comparing the traditional precautions with evidence-matched advice was found in the sources read, and the evidence is weakest for people who already have lymphoedema. How many services still teach the blanket prohibitions has not been measured in any source read.