In Making Choices Regarding Early Breast Cancer, More Is Not Always Better

More young women have been opting for mastectomy, even bilateral mastectomy, when breast-conserving therapy (BCT) is an appropriate choice. Assessing the long-term quality-of-life (QOL) outcomes of those who choose different options can inform future patients facing these decisions.

The Young Women's Breast Cancer Study — a large, multicenter, prospective, cross-sectional study of a cohort diagnosed with breast cancer between 2016 and 2017 — examined 560 patients (median age, 36) at stage 0–II. At a median of 5.8 years from diagnosis, 86% completed a QOL assessment using the BREAST-Q instrument, which has modules for each surgical option: BCT, mastectomy without reconstruction, and mastectomy with reconstruction. Several domains are evaluated, including satisfaction with breast outcome, psychosocial well-being, and physical and sexual well-being. Of the participating patients, 52% had bilateral mastectomy, 20% unilateral mastectomy, and 28% BCT.

The key finding: women who underwent more extensive surgery (mastectomy with or without reconstruction), especially when combined with radiation therapy, had lower QOL. That result was largely driven by less satisfaction with breasts as well as with psychosocial and sexual well-being. In addition to the surgical choice, lymphedema and greater weight had a negative influence on QOL. There was also a direct link observed between financial hardship and QOL across all domains.