Commentary on Al Onazi et al.

As highlighted by the authors, breast cancer remains the most prevalent cancer in women.Despite improvements in early detection, surgical technique advancements, and treatment that have improved survival rates, breast cancer-related lymphedema (BCRL) remains a frequent complication following cancer treatment. [1][2]2][3] The authors note an estimated incidence of 21% of survivors developing BCRL, while other studies have reported wider incidence rates ranging from 3% to 60%. 1,2These varying rates are influenced by factors such as the duration of follow-up, objective measures of lymphedema, and types of treatments (e.g., sentinel lymph node dissection, axillary lymph node dissection, chemotherapy, and/or regional lymph node radiotherapy).The authors stress that lymphedema is a chronic and progressive condition necessitating lifelong riskreduction and self-management practices for those affected by BCRL.Given the substantial evidence supporting the benefits of exercise in managing lymphedema without exacerbating symptoms or swelling, researchers and clinicians continue to advocate for exercise as a crucial component of lymphedema management.Although compression remains another critical pillar in lymphedema management, the authors conducted a systematic review to evaluate evidence on the need for or benefits of wearing compression garments during upper body exercise for lymphedema as this practice continues to be recommended by many researchers and clinicians to help patients manage their lymphedema.Using a rigorous screening method to identify eligible studies, the authors included 11 studies in their analysis.However, the absence of clear language inclusion criteria may have limited the review to studies published in a single language.This limitation can introduce language or publication bias, lead to the omission of valuable data, and restrict equity and inclusivity in research, ultimately influencing the outcomes of the systematic review.After conducting the systematic review, the authors highlighted numerous concerns -primarily heterogeneity and lack of quality research conducted in lymphedema research -that contributed to their inconclusive results.Below is a summary of some of the key factors that ultimately led to these inconclusive findings.