Choice of surgery may affect quality of life for young breast cancer survivors

Even as more young women with breast cancer opt to have mastectomies, many experience a persistent decline in their sexual and psychosocial well-being following the procedure, as detailed in new research by Dana-Farber/Brigham and Women’s Cancer Center. The findings, to be presented today at the San Antonio Breast Cancer Symposium, underscore the importance of counseling patients about the potential long-term physical and emotional consequences of the procedure, researchers say.

“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,” says the lead author of the study, Laura Dominici, MD, a surgeon at Dana-Farber/Brigham and Women’s 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.

“The decision of whether to have a mastectomy or breast-conserving surgery should be a shared decision between patients and their doctors,” she continues. “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.”

In this study, a patient reported outcomes survey known as BREAST-Q was completed by 561 women age 40 and younger with breast cancer. Patients who had a mastectomy scored markedly lower in three quality of life measures – satisfaction with the appearance of their breasts, psychosocial well-being, and sexual well-being – than patients who underwent breast-conserving surgery. The results were consistent regardless of whether the patients had one or both breasts removed, and despite the fact that most had breast reconstruction surgery.

A fourth area examined by the survey – physical function – was similar for women who had a mastectomy and those who had not. Women with financial difficulties tended to have lower scores in all four categories.

For breast satisfaction, those who had breast-conserving surgery had an average BREAST-Q score of 65.5, compared with 59.3 for the unilateral mastectomy group and 60.4 for the bilateral mastectomy group.

For psychosocial well-being, those who had breast-conserving surgery had an average BREAST-Q score of 75.9, compared with 70.6 for the unilateral mastectomy group and 68.4 for the bilateral mastectomy group.

For sexual well-being, those who had breast-conserving surgery had an average BREAST-Q score of 57.4, compared with 53.4 for the unilateral mastectomy group and 49 for the bilateral mastectomy group.

“These findings suggest that surgical choices may have long-term impact on quality of life,” Dominici said. “We really need to have more data about quality of life, particularly after surgery, because this information can help shape their decisions.”

Dominici added that further research could provide more information to clinicians as they advise patients of their options for breast cancer surgery. “In the future, I am hopeful that we will be able to predict quality of life outcome for an individual patient following the different types of surgery in order to help her decide what is best for her,” she said.

Dominici said the study’s primary limitation is that it was not randomized, and it evaluated quality of life only at a single time point. She added that researchers did not have information about women’s quality of life prior to the study, which could have affected their decision making and their post-surgery quality of life. 

This study was funded by the Agency for Healthcare Research and Quality, Susan G. Komen, the Breast Cancer Research Foundation, and The Pink Agenda. Dominici declares no conflicts of interest.