Young Women With Breast Cancer Who Undergo Mastectomy Report Lower Quality of Life

Laura Dominici, MD

Women who opt to undergo mastectomy may experience a drop in quality of life (QOL) compared with those who receive breast-conserving surgery, according to findings from a patient-reported outcomes survey recently published in JAMA Surgery. Scores did not appear to be impacted by breast reconstruction; however, socioeconomic stressors may have factored into the scores.

Specifically, women who underwent a bilateral mastectomy reported an average BREAST-Q score of 54.6, compared with 65.5 among women who received breast-conserving surgery. Regarding psychosocial well-being, the scores were 65.1 vs 75.9, respectively. In terms of sexual well-being, patients who underwent unilateral mastectomy had an average reported score of 53.4 compared with 46.2 among the bilateral mastectomy respondents, and 57.4 among those who had received breast-conserving surgery.

“Historically, it was felt that 75% of breast cancer patients should be eligible for breast conserving surgery. Over time, however, more women, particularly young women, are electing to have a mastectomy,” lead study author Laura Dominici, MD, a surgeon at Dana-Farber Brigham Cancer Center, said in a press release. “They frequently offer peace of mind as the reason for their decision—even though research shows that unless a woman has a genetic predisposition to breast cancer, she has a very low risk of developing cancer in the healthy breast.”

The BREAST-Q study assessed the responses of 560 women with stage 0 to III breast cancer, all of whom were 40 years or younger. The average age was 36 years. In addition, 484 had stage 0 to II disease. On average, participants were 5.8 years removed from their diagnosis.

Of the 560 respondents, 290 had received bilateral mastectomy (52%), 110 had received unilateral mastectomy (20%), and 160 had underwent breast-conserving therapy (28%).

Overall, patients who had received a mastectomy reported lower scores in all 3 QOL measures compared with those who received breast-conserving surgery. This outcome was consistent across both patients who had received bilateral or unilateral mastectomies. Assessed categories included breast appearance satisfaction, psychosocial well-being, and sexual well-being.

Among patients who underwent mastectomy, 357 (89%) received reconstruction and 181 (45%) received radiotherapy. Via a multivariate analysis, researchers concluded that implant-based reconstruction was associated with decreased breast satisfaction (β = −7.4; 95% CI, −12.8 to −2.1; P = .007), compared with autologous reconstruction and complex reconstruction was associated with decreased physical well-being (β = −14.0; 95% CI, −22.2 to −5.7; P < .001), compared with autologous.

Furthermore, researchers also queried about physical function as a fourth category and concluded that this measure was not significantly affected by mastectomy. In addition, financial difficulties were found to negatively impact responses in all 4 categories.

Study authors acknowledged that the study was not randomized; potentially limiting the findings. Furthermore, QOL was assessed at a singular moment in time. Lastly, researchers were not privy to the women’s QOL prior to the study, which may have factored into their decision making in terms of therapeutic surgery.

Dominici noted, “It is possible that women who chose mastectomy because of personal preference may perceive their QOL differently than women who underwent mastectomy because they were not candidates for BCT.”

Despite these potential limitations, the authors noted that patient reported outcomes surveys can reveal a lot about patient quality of life and are therefore important tools for identifying unmet needs in survivorship.

“The decision of whether to have a mastectomy or breast-conserving surgery should be a shared decision between patients and their doctors,” Dominici concluded. “Particularly when talking to young women, who are likely to have a long period of survivorship, it’s important that we as clinicians discuss the potential impacts of mastectomy on their QOL. As our study indicates, those impacts are not insignificant and persist years into the future.”

Reference

Dominici L, Hu J, Zheng Y, et al. Association of local therapy with quality-of-life outcomes in young women with breast cancer [published correction appears in JAMA Surg. 2021;156(10):989-990. JAMA Surg. 2021;156(10):e213758. doi:10.1001/jamasurg.2021.3758