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Mastectomy tied to poor QoL in young women with breast cancer

Elaine Soliven
10 Jan 2019

Younger women with breast cancer who had a mastectomy demonstrated a worse quality of life (QoL) compared with those who underwent breast-conserving surgery (BCS), according to a study presented at SABCS 2018.

“Historically, about 75 percent of women are eligible for BCS. However, over time, more women, and particularly young women, are electing for bilateral mastectomy,” said lead author Dr Laura Dominici from Brigham and Women's Hospital, Boston, Massachusetts, US, who found that mastectomy, especially unilateral or bilateral, was associated with a significant decrease in QoL than BCS.

Using data from the YWS* database, the researchers conducted a prospective cohort study involving 560 young women with breast cancer (median age at diagnosis, 37 years) from 12 hospitals in the US. BREAST-Q domains, such as psychosocial, sexual, and physical wellbeing as well as breast satisfaction, were assessed to validate the patient-reported outcomes across three different surgeries. The most common type of surgery was bilateral mastectomy at 52 percent, followed by BCS at 28 percent, and unilateral mastectomy at 20 percent. [SABCS 2018, abstract GS6-06]

Women who underwent mastectomy had a significantly worse QoL than those who had a BCS, as shown by lower BREAST-Q scores for psychosocial wellbeing (mean score, 68.4 and 70.6 for bilateral and unilateral, respectively, vs 75.9; p<0.001) and sexual wellbeing (mean score, 49 and 53.4 for bilateral and unilateral, respectively, vs 57.4; p<0.001).

A significantly lower BREAST-Q score for breast satisfaction was also observed among women who had a mastectomy compared with those who had a BCS (mean score, 60.4 for bilateral and 59.3 for unilateral vs 65.5; p=0.008).

With regard to physical wellbeing, there was no significant BREAST-Q score difference across all surgeries (mean score, 78.7 for bilateral and 78.9 for unilateral mastectomies vs 78.9 for BCS; p=0.8).

Moreover, a multivariate analysis showed that patients who had a BMI of ≥25 kg/m2 demonstrated a decrease in QoL domains, indicating a negative beta score difference in BREAST-Q score, for psychosocial (ß, -4.2; p=0.03) and sexual wellbeing (ß, -5.3; p=0.006).

“Local therapy decisions are associated with a persistent impact on QoL in young breast cancer survivors,” said Dominici, who added that “knowledge of the potential long-term impact of surgery on QoL is of critical importance for counselling young women about surgical decisions.”

“We really need to have more data about QoL, particularly after surgery, because this information can help shape their decisions,” she added.

 

*YWS: Young Women’s Breast Cancer Study

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