Bilateral Mastectomy Possibly Linked to Poor Self-Image Among Young Breast Cancer Survivors

A recent study of female breast cancer survivors shows that feelings toward body image were consistently worse among those who had a bilateral mastectomy (BM) vs breast-conserving surgery (BCS), reports JAMA Surgery.

“Among younger women, understanding the impact of BM relative to less extensive surgery on health-related and psychological health outcomes is critical given that younger women experience greater psychosocial distress at and after diagnosis,” the study authors indicated. They looked at years 1 through 5 post surgery, adding that these outcomes have mostly been examined among postmenopausal women.

In the study, quality of life and psychosocial outcomes were evaluated as they related to physical functioning, body image, sexual health, and anxiety and depressive symptoms following surgery for stage 0 to 3 unilateral breast cancer. These women, aged 40 years or younger at the time of diagnosis, underwent either BM (45.4%), BCS (30.8%), or unilateral mastectomy (UM; 23.8%).

Overall, physical functioning, sexuality, and body image improved; however, for women who underwent BM compared with BCS, body image and sexuality were worse at year 5 compared with year 1 (all P < .001):

• Body image:
  • Year 1: 1.32 vs 0.64, respectively
  • Year 5: 1.19 vs 0.48
• Sexuality:
  • Year 1: 1.66 vs 1.20
  • Year 5: 1.43 vs 0.96

Similar outcomes were seen for women who underwent BM vs UM:

• Body image:
  • Year 1: 1.32 vs 1.15, respectively (P = .06)
  • Year 5: 1.19 vs 0.96 (P = .02)
• Sexuality:
  • Year 1: 1.66 vs 1.41 (P = .02)
  • Year 5: 1.43 vs 1.09 (P = .002)

Among the 826 (BM, n = 375; BCS, n = 254; UM, n = 197) women included in the final analysis, the mean ages across the cohorts were almost equal at 36.1, 35.9, and 36.4 years for those who underwent BM, BCS, and UM, respectively. Most (86.7%) were non-Hispanic White.

Of those who underwent either UM or BM, 83.6% had breast reconstruction, while 39.3% and 52.8%, respectively, also had postmastectomy radiation therapy. Most women in each cohort (UM, 79.1%; BM, 75.2%; BCS, 66.5%) also underwent chemotherapy and tested negative for BRCA 1/2 or TP53 (2.1% vs 20.1% vs 3.2%, respectively).

Anxiety improved across the board, but mean anxiety scores were highest in the BM group at the 1-, 2-, and 5-year marks vs the women who had BCS or UM:

• Year 1: 7.75 vs 6.94 vs 6.58 (P = .005)
• Year 2: 7.47 vs 6.18 vs 6.07 (P < .001)
• Year 5: 6.67 vs 5.91 vs 5.79 (P = .05)

Study data were provided from the Young Women’s Breast Cancer Study. Physical functioning was evaluated using Cancer Rehabilitation Evaluation System Short Form, and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale.

“Our study provides novel and comprehensive information about how several dimensions of QOL and psychosocial health are affected both in the short and long term among young women who undergo breast cancer surgery,” the authors concluded. “Understanding how outcomes differ and change over time may be useful to newly diagnosed women making preference-sensitive surgical decisions and should be communicated by clinicians during the decision process.”

Study limitations on interpreting their results include the small sample size for certain subgroups and that most participants were non-Hispanic white women.

Reference

Rosenberg SM, Dominici LS, Gelber S, et al. Association of breast cancer surgery with quality of life and psychosocial well-being in young breast cancer survivors. JAMA Surg. Published online September 16, 2020. doi:10.1001/jamasurg.2020.3325