Breast-conserving therapy may be associated with improved sexual well-being compared with mastectomy followed by breast reconstruction in patients with breast cancer, according to a recent study published by Stern et al in Plastic and Reconstructive Surgery.
Background
Many patients with breast cancer experience sexual health issues. Previous studies have determined that despite up to 85% of those with breast cancer reporting sexual dysfunction, a low proportion of them receive any medical guidance for the condition.
Breast-conserving therapy often serves as an effective alternative to mastectomy in patients with breast cancer. Among those who undergo mastectomy, breast reconstruction has established benefits in terms of quality of life and self-esteem.
However, there have been few studies focused on sexual well-being in breast cancer treatment, especially in comparing the outcomes of breast-conserving therapy with postmastectomy breast reconstruction.
Study Methods and Results
In the study, investigators used a validated BREAST-Q questionnaire to analyze the sexual well-being scores of 15,857 patients who underwent breast cancer surgery between 2010 and 2022. About 54% of the patients underwent breast-conserving therapy and 46% of them underwent postmastectomy breast reconstruction. Scores on a sexual well-being subscale—addressing sexual attractiveness, sexual confidence, and comfort level during sex—were compared between both patient groups, including long-term follow-up when available.
Prior to surgery, the investigators observed similar average scores for sexual well-being among the two groups. On a scale of 0 to 100, the patients in the breast-conserving therapy and postmastectomy breast reconstruction groups reported scores of 62 and 59, respectively. After a follow-up of 6 months, sexual well-being score in the breast-conserving therapy group increased to 66 and remained around that level at up to 5 years.
At all times, the patients undergoing postmastectomy breast reconstruction had lower sexual well-being scores compared with those who received breast-conserving therapy. Average scores were 49 at 6 months was 49 and 53 with longer follow-up. The sexual well-being score was even lower, with an average of 41 among the patients who had not yet completed breast reconstruction by the end of the study period.
Overall, scores averaged 7.6 points higher in the breast-conserving therapy group. Sexual well-being was significantly correlated with scores in other BREAST-Q domains, including physical well-being of the chest, satisfaction with breasts, and psychosocial well-being.
In spite of the impact on sexual well-being, just 3.5% of the patients in the breast-conserving therapy group and 5.4% of those in the postmastectomy breast reconstruction group received sexual drug consultation, which was available from a dedicated service at the investigators’ cancer center. After adjusting for other factors, patients in the postmastectomy breast reconstruction group were about 50% as likely to receive sexual drug consultation.
Conclusions
“In our study, patients undergoing [breast-conserving therapy] scored consistently higher on a measure of sexual well-being compared to total mastectomy and breast reconstruction,” emphasized senior study author Jonas A. Nelson, MD, MPH, of Memorial Sloan Kettering Cancer Center. “The findings highlight the need for increased attention to sexuality when discussing breast cancer treatment options,” he continued.
The findings added to previous evidence that patients undergoing breast-conserving therapy for breast cancer may recover sexual well-being more quickly compared with those undergoing postmastectomy breast reconstruction. The investigators emphasized the need to consider and discuss the impact of breast cancer surgery on sexual well-being.
“[Among patients with] breast cancer who are eligible for either [breast-conserving therapy] or mastectomy, [breast-conserving therapy] may be the superior choice for patients who wish to maintain their sexual well-being,” the study authors underscored.
“Although many patients have low sexual health, most do not receive sexual [drug] consultation, suggesting an opportunity for providers to improve sexual health [among patients with breast cancer],” Dr. Nelson concluded.
Disclosure: For full disclosures of the study authors, visit journals.lww.com.
