Purpose/objectives: To examine the severity and development of breast and arm symptoms separately during the two years following breast cancer surgery, and to examine whether previously defined predictors of arm symptoms are associated with breast symptoms.

Design: Prospective cohort study with two-year follow-up.

Setting: Three institutions in the Stockholm, Sweden, region.

Sample: 645 women, aged 20-63 years, enrolled within 12 weeks of surgery for primary breast cancer.

Methods: Baseline register and questionnaire data with five follow-ups were submitted to descriptive, inferential, and logistic regression analysis.

Main research variables: Severity of breast and arm symptoms measured by the European Organisation for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire.

Findings: Most participants had undergone breast-conserving surgery and sentinel lymph node dissection, and were scheduled for postoperative radiation therapy. Overall mean levels of breast and arm symptoms were low, but with large individual variations. At all six time points, the mean levels of breast symptoms were significantly higher than those of arm symptoms. Overall, the mean level of both types of symptoms decreased during follow-up. A body mass index (BMI) of 25 or greater and breast symptoms at eight months were associated with having breast symptoms at two years. Arm symptoms at baseline and at eight months, and radiation therapy and a BMI of 25 or greater were associated with having arm symptoms at two years.

Conclusions: Breast symptoms show different patterns of change and are not associated with the same factors as arm symptoms.

Implications for nursing: For nurses monitoring women treated for breast cancer, the results of this study provide knowledge regarding the importance of early symptom identification and long-term symptoms after treatment.