Surviving Breast Cancer, Quality of Life Post Surgery

October is Breast Cancer awareness month and Unhurry is dedicated to spread the right information.

A recent study has shed light on how the choice of surgical procedure among young women with early-stage breast cancer can significantly affect their long-term quality of life. The research discovered that women who opted for unilateral or bilateral mastectomy (the removal of one or both breasts) tended to report lower scores on a quality-of-life survey, indicating a diminished overall quality of life when compared to those who underwent breast-conserving surgery, which involves removing the tumor and some surrounding healthy tissue.

To gather this data, the researchers distributed a questionnaire known as BREAST-Q to 560 young breast cancer survivors who were 40 years or younger at the time of their diagnosis. The questionnaire covered various aspects, such as their satisfaction with the results of their surgery, their psychosocial well-being (including anxiety levels), and their sexual well-being.

The responses provided insights into the impact of different surgical procedures on these aspects of women’s lives. Notably, women who had mastectomies followed by radiation therapy reported the lowest scores, signifying a lower quality of life. This study, published in JAMA Surgery on September 1, underscores the long-lasting consequences of surgical choices for breast cancer patients.

Dr. Laura Dominici, a surgeon at the Dana-Farber Brigham Cancer Center who led the study, stressed the importance of these findings, stating that “surgical choices that women with breast cancer make can have an impact on their long-term quality of life.” She emphasized the need for clinicians to engage in discussions with their patients about the potential effects of different treatment options on their quality of life.

In cases of early-stage breast cancer, patients often have several surgical treatment options. While studies have shown that these options have similar survival rates and risks of cancer recurrence, mastectomies tend to carry a higher risk of surgical complications compared to breast-conserving surgery.

Despite these similarities in outcomes, there is a growing trend in the United States where more women with early-stage breast cancer are opting for mastectomy. This includes cases where patients have cancer in just one breast and still choose to undergo a contralateral prophylactic mastectomy, a procedure that removes the healthy breast.

In the study, the majority of participants had early-stage breast cancer and were potential candidates for breast-conserving surgery, such as lumpectomy. However, 72% of them chose mastectomy (with 20% opting for unilateral mastectomy and 52% for bilateral), while only 28% chose breast-conserving surgery.

The survey participants completed the BREAST-Q questionnaire approximately 5.8 years after their cancer diagnosis. Most of them were White, married, financially stable, and had a college education.

The questionnaire asked participants to evaluate various aspects on a scale from 0 to 100, with higher scores indicating more favorable outcomes. It covered topics like breast satisfaction, including how participants felt about the appearance, touch, and matching of their breasts, as well as their confidence in social situations, emotional health, and self-esteem.

Dr. Monica Morrow, a breast surgeon at Memorial Sloan Kettering Cancer Center, emphasized the importance of integrating the results from this study into patient counseling. She suggested that discussions about the merits of mastectomy versus breast-conserving therapy should include the lower quality-of-life scores associated with mastectomy.

Dr. Morrow also highlighted that women with early-stage breast cancer have a low risk of developing cancer in the other breast. This information, along with the lack of survival benefits and higher surgical complication risks with mastectomy, should be conveyed to patients.

The study’s findings also point out the increasing use of radiation therapy after mastectomy, which is concerning given the observed decrease in breast satisfaction among women who undergo mastectomy, particularly when combined with post-mastectomy radiation therapy.

Dr. Dominici concluded that it’s crucial for patients to understand that choosing mastectomy may potentially result in a poorer quality of life, especially when radiation therapy follows the procedure. These results underscore the significance of researching cancer survivor experiences, enabling women considering breast surgery to make informed decisions that align with their long-term well-being.

It’s important to note that the study has limitations, such as the questionnaire being completed only at a single point in time and the lack of information regarding participants’ quality of life when they made their surgery choices. Additionally, the results may not be broadly applicable to women outside the specific demographic of the study’s participants, which included mostly White, married, and college-educated individuals. Dr. Dominici emphasized the importance of discussing quality of life with patients, a topic that may not have received enough attention in the past.

Breast cancer is the most commonly diagnosed cancer in women, and it remains a leading cause of cancer-related deaths among women. In 2018, nearly two million cases of breast cancer were diagnosed globally, accounting for a significant portion of all cancer cases in women. In 2019, for example, Italy reported 53,000 new cases of breast cancer, making it the most frequently diagnosed cancer in women in that country.

Although breast cancer remains a significant health concern, there has been substantial progress in improving survival rates. Five-year survival rates are now around 90%, and 10-year survival rates are approximately 80%, particularly in Western countries with effective screening programs. The increased survival rates are attributed to two main factors:

Early Diagnosis: Effective population screening programs, especially through mammography, have led to the early detection of breast cancer when it is still at a subclinical stage, allowing for more successful treatment.

Personalized Treatment: Advances in molecular characterization of breast cancer subtypes have enabled the development of targeted therapies, especially for hormone-sensitive and HER2-positive breast cancers.

Additionally, improvements in treatment options, including the use of CDK 4/6 inhibitors and other innovative therapies, have extended the survival of metastatic breast cancer patients, turning it into a chronic disease for many.

As breast cancer survival rates increase, there is a growing need for strategies to manage the long-term effects of breast cancer treatments, with a particular focus on maintaining the quality of life. This includes addressing issues like cardiotoxicity due to adjuvant therapies, fertility preservation, bone health, and psychological and sexual well-being.

In summary, breast cancer survival has significantly improved in recent years, thanks to early detection and more personalized treatments. However, it’s essential to address the long-term consequences of treatments and provide support for the overall well-being of breast cancer survivors.

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