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SABCS 2018: Surgical Choice May Impact Long-Term Quality of Life in Young Adults With Breast Cancer

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Key Points

  • Women who chose breast-conserving surgery over mastectomy scored higher in breast satisfaction and in psychosocial and sexual well-being than those who opted for either unilateral or bilateral mastectomy.
  • When counseling young women about their surgical options, clinicians should provide as much information as possible about their long-term outcomes, including quality of life.

A study by Dominici et al investigated the long-term quality of life outcomes in young breast cancer survivors across three surgical strategies: breast-conserving surgery, unilateral mastectomy, and bilateral mastectomy. The researchers found that patients who underwent mastectomy had lower breast satisfaction and poorer psychosocial and sexual well-being compared to women who had breast-conserving surgery. The study was presented at the 2018 San Antonio Breast Cancer Symposium (Abstract GS6-06).

Previous studies have shown that the rate of mastectomy, primarily bilateral mastectomy, is rising among younger women with breast cancer, but the impact on how the decision affects their long-term quality of life was unknown. The study by Dominici et al suggests that when counseling young women about their surgical options, clinicians should provide as much information as possible about long-term outcomes, including quality of life.

“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."

Study Methodology

Between October 2016 and November 2017, the researchers administered the BREAST-Q questionnaire to 561 women who had been diagnosed with stage 0 to III breast cancer and were enrolled in a large prospective cohort study. The median age at diagnosis was 37. Demographic and treatment information were obtained by surveys and chart review.

Mean BREAST-Q scores for each domain (breast satisfaction, physical, psychosocial, and sexual) were compared by surgery type, including bilateral mastectomy, unilateral mastectomy, or breast-conserving surgery. Among the women surveyed, 28% had breast-conserving surgery and 72% had a mastectomy. Among the women who had mastectomies, 72% had bilateral procedures and 89% had reconstructive surgery.

Higher BREAST-Q scores (range = 0–100) indicate better quality of life. Linear regression was used to identify predictors of BREAST-Q domain scores.

Key Results

The researchers found that the mean BREAST-Q scores for breast satisfaction and psychosocial or sexual well-being were lower for women who had a mastectomy or bilateral mastectomy than they were for those who had breast-conserving surgery. Physical function was similar among all three groups.

For breast satisfaction, patients who chose breast-conserving surgery had an average BREAST-Q score of 65.9, compared with 59.5 for the unilateral mastectomy group and 60.3 for the bilateral mastectomy group. For psychosocial well-being, women who chose breast-conserving surgery had an average score of 76.1, compared with 70.5 for the women who chose a unilateral mastectomy and 68.1 for women who chose a bilateral mastectomy. For sexual well-being, the women who had breast-conserving surgery again scored highest, 57.5, compared with 53.2 for women in the unilateral mastectomy group and 48.6 for those in the bilateral mastectomy group.

“Local therapy in young breast cancer survivors may have a persistent impact on their breast satisfaction, psychosocial, and sexual outcomes, with particular effects from [unilateral mastectomy] or [bilateral mastectomy]. Socioeconomic stressors also appear to play a role. When counseling young women about their surgical decisions, knowledge of potential long-term quality-of-life impact is of critical importance,” concluded the study authors.

Disclosure: The study was funded by the Agency for Healthcare Research and Quality, Susan G. Komen, the Breast Cancer Research Foundation, and The Pink Agenda. See the study authors’ full disclosures at sabcs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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