In a study reported in JAMA Surgery, Hanson et al found no difference in long-term satisfaction with breasts among women with early breast cancer who underwent breast-conserving surgery with radiation therapy vs mastectomy and breast reconstruction without radiation therapy. Women who underwent mastectomy and reconstruction without radiotherapy reported poorer psychosocial and sexual well-being.
Study Details
The study used data from the Texas Cancer Registry for women diagnosed with stage 0 to II breast cancer and treated with breast-conserving surgery or mastectomy and reconstruction between 2006 and 2008. A total of 1,616 patients, including 980 who had undergone breast-conserving surgery and 636 who had undergone mastectomy and reconstruction, were mailed a survey between March 2017 and April 2018.
The primary outcome measure was satisfaction with breasts, assessed with the BREAST-Q patient-reported outcome instrument. Physical well-being, psychosocial well-being, and sexual well-being were assessed using BREAST-Q; health utility was assessed using the EuroQol Health-Related Quality of Life 5-Dimension/3-Level questionnaire; and treatment decision regret was assessed using the Decisional Regret Scale. Scores were transformed to a 0 to 100 scale (higher = better), with clinically significant difference defined as an absolute difference of at least 8 points.
Key Findings
Among 647 women who responded to the survey (40.0%), 356 had undergone breast-conserving surgery and 291 had undergone mastectomy with reconstruction. Median age was 53 years (range = 23–85 years) and median time from diagnosis to survey was 10.3 years (range = 8.4–12.5 years).
On multivariate analysis, no significant difference between the breast-conserving surgery group vs the mastectomy with reconstruction group was observed for satisfaction with breasts (effect size = 2.71, 95% confidence interval [CI] = –2.45 to 7.88, P = .30).
Similarly, no significant differences between the breast-conserving surgery group vs the mastectomy with reconstruction group were observed for physical well-being (effect size = –1.80, 95% CI = –5.65 to 2.05, P = .36), health utility (effect size = –0.003, 95% CI = –0.03 to 0.03, P = .83) or decisional regret (effect size = 1.32, 95% CI = –3.77 to 6.40, P = .61).
Compared with the breast-conserving surgery group, the mastectomy with reconstruction group reported significantly poorer psychosocial well-being (effect size = –8.61, 95% CI = –13.26 to –3.95, P < .001) and sexual well-being (effect size = –10.68, 95% CI = –16.60 to –4.76, P < .001).
The investigators concluded: “The findings support equivalence of breast-conserving surgery with [radiotherapy] and mastectomy and reconstruction without [radiotherapy] with regard to breast satisfaction and physical well-being. However, breast-conserving surgery with [radiotherapy] was associated with clinically meaningful improvements in psychosocial and sexual well-being. These findings may help inform preference-sensitive decision-making for women with early-stage breast cancer.”
Benjamin D. Smith, MD, of the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, is the corresponding author for the JAMA Surgery article.
Disclosure: The study was supported by the Andrew Sabin Family Fellowship, Cancer Prevention and Research Institute of Texas, National Cancer Institute, and others. For full disclosures of the study authors, visit jamanetwork.com.
