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SAN ANTONIO – Women who opted for mastectomy rather than breast-conserving surgery for early breast cancer had worse quality of life regarding their psychosocial and sexual well-being, according to survey results reported here.

Among 560 women who had undergone breast cancer surgery, those who had breast-conserving surgery or lumpectomy scored 65.5 on a 100-point scale in expressing satisfaction with their breasts compared with 60.4 for women who instead opted for bilateral mastectomy in response to a breast cancer diagnosis and 59.3 for women who had a unilateral mastectomy (P=0.008), reported Laura Dominici, MD, of Dana Farber/Brigham and Women's Cancer Center/Harvard Medical School in Boston.

In a press conference at the San Antonio Breast Cancer Symposium, Dominici said that the survey showed the following key points:

• On the quality of life Breast-Q instrument, women who had lumpectomy had a 75.9 score out of 100 on psychosocial aspects of life such as anxiety and depression after surgery compared with 68.4 for those who had a bilateral mastectomy and 70.6 for those who had a unilateral mastectomy (P=0.001)
• Regarding sexual well-being, women who had lumpectomy had a 57.4 score out of 100 compared with 49 for women who had a bilateral mastectomy and 53.4 for those who had a unilateral mastectomy (P<0.001)

On the other hand, scores for physical well-being differed not at all among those having lumpectomy (mean score 78.9), bilateral mastectomy (78.7), or unilateral mastectomy (78.9).

"We found that local therapy decisions are associated with a persistent impact on quality of life in young breast cancer survivors," Dominici said, noting that the lower quality of life scores for women who had mastectomy persisted even though 80% of those surveyed had undergone some form of breast reconstruction.

"Knowledge of the potential long-term impact of surgery on quality of life is of critical importance for counseling young women about surgical decisions," she said. "While we can tell our patients that the outcomes on survival are the same, I don't know if that changes their decision, but perhaps if we inform them that the long-term quality of life is worse, that may change their decisions."

She noted that in 1998 just 3.6% of women diagnosed with breast cancer chose bilateral mastectomy, but by 2011 that percentage had increased to 33%.

Dominici said that even though local regional control of breast cancer with breast-conserving therapy and mastectomy have equivalent survival outcomes, in the sample of women surveyed, just 28% of participants opted to have lumpectomy. 20% of the women underwent unilateral mastectomy and 52% elected to have bilateral mastectomy.

The women in the study had a mean age of 37; approximately 90% were Caucasian; 32% had a body mass index greater than 25; a total of 61% were working full time; and 86% were college graduates or had done post-graduate studies.

Dominici said about 10% of the patients in her study had genetic factors predisposing them to breast cancer, but that the team has not yet analyzed that group to determine their choices for surgery.

The survey was sent to 743 women who were age 40 or younger who had been diagnosed with breast cancer, and eventually 560 of the returned surveys had complete enough information to be included in the study.

Kent Osborne, MD, director of the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine in Houston and a co-director of the symposium, said: "These data are more disconcerting when you consider the high mastectomy rate in this country relative to Europe. In some cases the use of bilateral mastectomy is ridiculous, because it doesn't improve your outcome and yet it does have deleterious effects on psychosocial well-being.

"I think I spend more time trying to talk patients out of having a bilateral mastectomy than anything else," he said.

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