Katharine Arnold, Dan Eckstein, Journal of the National Cancer Institute: September 6, 2000
A new study reports that women whose breast cancer was treated by mastectomy or mastectomy with reconstruction complained of more physical symptoms after surgery than women treated by lumpectomy, but the groups did not differ in their self-assessments of emotional, social, or role functioning.
Study leader Julia Rowland, Ph.D., of the National Cancer Institute, and colleagues, present their results in the Sept. 6 issue of the Journal of the National Cancer Institute. They conclude that a woman’s quality of life after breast cancer surgery is more likely influenced by her age or exposure to adjuvant therapy than what type of surgery she had. However, women who had reconstructive surgery after mastectomy were most likely to report that treatment had a negative impact on their sex lives (45.4% versus 29.8% for lumpectomy and 41.3% for mastectomy alone).
The study involved detailed surveys of breast cancer survivors in Los Angeles, Calif., and Washington, D.C. Women who had been diagnosed with breast cancer from 1 to 5 years before study entry were identified through a variety of mechanisms, including local tumor registries, physician practices, and treatment clinic logs or charts. More than 6000 breast cancer survivors were invited to participate in the study, about 60% responded to the invitation, and a total of 1957 women completed questionnaires. The questionnaire included a number of standardized measures of health-related quality of life, body image, and physical and sexual functioning.
More than one half (57%) of the women who completed the survey underwent lumpectomy, 26% had mastectomy alone, and 17% had mastectomy with reconstruction. Women in the mastectomy with reconstruction group were younger than those in the lumpectomy or mastectomy-alone groups (mean ages = 50.3, 55.9, and 58.9, respectively); they were also more likely to have a partner and to be college educated, affluent, and white.
Reconstructive surgery was of less benefit to body image than anticipated, since scores on the body-image scale for the mastectomy with reconstruction group were closer to those for the mastectomy-alone group than scores for the lumpectomy group. As expected, women in the lumpectomy group reported fewer problems with their body image and feelings of sexual attractiveness than women in either the mastectomy with reconstruction or the mastectomy-alone groups.
Mastectomy patients, with or without reconstruction, experienced more physical symptoms and more discomfort around the surgical site than women who had a lumpectomy. These symptoms included the sensation of pins and needles (reported as often in 13% of mastectomy-alone women) and numbness (a common problem for 52% of the women who underwent breast reconstruction). Almost twice as many mastectomy-alone (46.6%), as lumpectomy (24.0%), or mastectomy with reconstruction (25.8%) group members reported problems with arm swelling.
The authors conclude that studies such as theirs can provide a benchmark against which to measure progress toward improving not only women’s survival from breast cancer but also their quality of life after breast cancer.
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Note: The majority of reconstruction patients had breast implants; others had autologous tissue transfer surgery.