Many young women with breast cancer choose mastectomies but afterwards experience a persistent decline in their sexual and psychosocial well-being, according to new research reported in JAMA Surgery.
In surveys conducted after patients underwent breast cancer surgery, significant quality of life (QoL) impacts were seen with mastectomies, with a greater extent of surgery worsening the QoL outcomes. The findings are important in light of recent trends towards younger women with breast cancer opting for bilateral mastectomies for unilateral breast cancer when breast conserving surgery was also an option.
“Historically, it was felt that 75 percent of breast cancer patients should be eligible for breast conserving surgery. Over time, however, more women, particularly young women, are electing to have a mastectomy,” said study lead author Laura Dominici, MD, a surgeon at Dana-Farber Brigham Cancer Center. “They frequently offer peace of mind as the reason for their decision – even though research shows that unless a woman has a genetic predisposition to breast cancer, she has a very low risk of developing cancer in the healthy breast.”
In this study, 560 participants, 40 and younger with breast cancer, filled in a patient reported outcomes survey known as BREAST-Q, an average 5.8 years after diagnosis.
Compared to those who had breast-sparing surgery, patients who had a mastectomy scored significantly lower in three QoL measures – satisfaction with the appearance of their breasts, psychosocial well-being, and sexual well-being. The results were consistent regardless of whether one or both breasts were removed, and that most had breast reconstruction surgery.
- For breast satisfaction, patients who had breast-conserving surgery had an average BREAST-Q score of 65.5, compared with 54.6 in the bilateral mastectomy group.
- For psychosocial well-being, patients who had breast-conserving surgery had an average BREAST-Q score of 75.9, compared with 65.1 in the bilateral mastectomy group.
- For sexual well-being, patients who had breast-conserving surgery had an average BREAST-Q score of 57.4, compared with 53.4 for the unilateral mastectomy group and 46.2 for the bilateral mastectomy group.
A fourth area examined by the survey, physical function, showed no difference between the groups. Women with financial challenges tended to have lower scores in all four categories.
“The decision of whether to have a mastectomy or breast-conserving surgery should be a shared decision between patients and their doctors,” Dr Dominici added. “Particularly when talking to young women, who are likely to have a long period of survivorship, it’s important that we as clinicians discuss the potential impacts of mastectomy on their quality of life. As our study indicates, those impacts are not insignificant and persist years into the future.”
The study’s main limitation is that it was not randomised, and quality of life was only evaluated at a single time point. Dr Dominici added there was no information about women’s quality of life prior to the study, which could have infuenced their decision making and their quality of life after surgery.
Source: Dana-Farber Cancer Institute
