Upper-body morbidity following breast cancer: incidence and evidence for evaluation, prevention and management within a prospective surveillance model of care Running title: Upper-body morbidity following breast cancer Authors:

The purpose of this paper is to review the incidence of upper-body morbidity (arm and breast symptoms, impairments and lymphedema), methods for diagnosis, and prevention and treatment strategies. It was also the purpose to highlight the evidence-base for integration of prospective surveillance for upper-body morbidity within standard clinical care of women with breast cancer. Between 10-64% of women report upper-body symptoms between 6-months to 3 years post-breast cancer and approximately 20% develop lymphedema. Symptoms remain common into longer-term survivorship and while lymphedema may be transient for some, those who present with mild lymphedema are at increased risk of developing moderate-severe lymphedema. The etiology of morbidity seems to be multifactorial, with the most consistent risk factors being those associated with extent of treatment. However, known risk factors cannot reliably distinguish between those who will and will not develop upper-body morbidity. Upperbody morbidity may be treatable with physical therapy. There is also evidence in support of integrating regular surveillance for upper-body morbidity into the routine care provided to women with breast cancer, with early diagnosis potentially contributing to more effective management and prevention of progression of these conditions.