Laura Dominici1,2, Jiani Hu3, Yue Zheng3, Hee Jeong Kim4,5, Tari A King1, Kathryn J Ruddy6, Rulla M Tamimi7, Jeffrey Peppercorn8, Lidia Schapira9, Virginia F Borges10, Steven E Come11, Ellen Warner12, Julia S Wong13,14, Ann H Partridge4, Shoshana M Rosenberg4. 1. Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 2. Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts. 3. Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts. 4. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. 5. Asan Medical Center, Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea. 6. Mayo Clinic, Rochester, Minnesota. 7. Weill Cornell Medicine, New York, New York. 8. Massachusetts General Hospital, Boston, Massachusetts. 9. Stanford University, Palo Alto, California. 10. University of Colorado Cancer Center, Aurora. 11. Beth Israel Deaconess Medical Center, Boston, Massachusetts. 12. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 13. Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts. 14. Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Abstract
Importance: Increasing rates of bilateral mastectomy have been most pronounced in young women with breast cancer, but the association of surgery with long-term quality of life (QOL) remains largely unknown. Objective: To examine the association of surgery with longer-term satisfaction and QOL in young breast cancer survivors. Design, Setting, and Participants: This multicenter cross-sectional study of a prospective cohort was conducted from October 2016 to November 2017, at academic and community hospitals in North America. Women 40 years or younger enrolled in the Young Women's Breast Cancer Study were assessed. Data analysis was performed from during a 1- to 2-year period after conclusion of the study. Exposures: Primary breast surgery, reconstruction, and radiotherapy. Main Outcomes and Measures: Mean BREAST-Q breast satisfaction and physical, psychosocial, and sexual well-being scores were compared by type of surgery; higher BREAST-Q scores (range, 0-100) indicate better QOL. Linear regression was used to identify demographic and clinical factors associated with BREAST-Q scores for each domain. Results: A total of 560 women with stage 0 to III breast cancer (median age at diagnosis, 36 years; range, 17-40 years; 484 [86%] with stage 0-II disease) completed the BREAST-Q a median of 5.8 years (range, 1.9-10.4 years) from diagnosis. A total of 290 patients (52%) of patients underwent bilateral mastectomy, 110 patients (20%) underwent unilateral mastectomy, and 160 patients (28%) received breast-conserving therapy. Among mastectomy patients, 357 (89%) had reconstruction and 181 (45%) received radiotherapy. In multivariate analyses, implant-based reconstruction (vs autologous) was associated with decreased breast satisfaction (β = -7.4; 95% CI, -12.8 to -2.1; P = .007) and complex reconstruction (vs autologous) with worse physical well-being (β = -14.0; 95% CI, -22.2 to -5.7; P < .001). Conclusions and Relevance: These results suggest that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.
Importance: Increasing rates of bilateral mastectomy have been most pronounced in young women with breast cancer, but the association of surgery with long-term quality of life (QOL) remains largely unknown. Objective: To examine the association of surgery with longer-term satisfaction and QOL in young breast cancer survivors. Design, Setting, and Participants: This multicenter cross-sectional study of a prospective cohort was conducted from October 2016 to November 2017, at academic and community hospitals in North America. Women 40 years or younger enrolled in the Young Women's Breast Cancer Study were assessed. Data analysis was performed from during a 1- to 2-year period after conclusion of the study. Exposures: Primary breast surgery, reconstruction, and radiotherapy. Main Outcomes and Measures: Mean BREAST-Q breast satisfaction and physical, psychosocial, and sexual well-being scores were compared by type of surgery; higher BREAST-Q scores (range, 0-100) indicate better QOL. Linear regression was used to identify demographic and clinical factors associated with BREAST-Q scores for each domain. Results: A total of 560 women with stage 0 to III breast cancer (median age at diagnosis, 36 years; range, 17-40 years; 484 [86%] with stage 0-II disease) completed the BREAST-Q a median of 5.8 years (range, 1.9-10.4 years) from diagnosis. A total of 290 patients (52%) of patients underwent bilateral mastectomy, 110 patients (20%) underwent unilateral mastectomy, and 160 patients (28%) received breast-conserving therapy. Among mastectomy patients, 357 (89%) had reconstruction and 181 (45%) received radiotherapy. In multivariate analyses, implant-based reconstruction (vs autologous) was associated with decreased breast satisfaction (β = -7.4; 95% CI, -12.8 to -2.1; P = .007) and complex reconstruction (vs autologous) with worse physical well-being (β = -14.0; 95% CI, -22.2 to -5.7; P < .001). Conclusions and Relevance: These results suggest that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.
Authors: Megan E Tesch; Shoshana M Rosenberg; Laura C Collins; Julia S Wong; Laura Dominici; Kathryn J Ruddy; Rulla Tamimi; Lidia Schapira; Virginia F Borges; Ellen Warner; Steven E Come; Ann H Partridge Journal: Ann Surg Oncol Date: 2022-08-12 Impact factor: 4.339