Less Surgery Shown to Preserve Better Long-Term Quality of Life in Patients With Early-Stage Breast Cancer

Mastectomy and breast reconstruction surgery were associated with significantly worse psychosocial and sexual well-being outcomes in women with early-stage breast cancer when compared with breast-conserving surgery, such as a lumpectomy, and radiation therapy, according to recent study results.

The findings, lead study author Dr. Benjamin D. Smith noted, highlight that less may be more when it comes to treating patients with early-stage breast cancer.

The study findings demonstrated that psychosocial well-being and sexual well-being outcomes were significantly worse in patients who had a mastectomy and breast reconstruction, compared with those who underwent a minimally invasive surgery plus radiation treatment.

“There hasn’t been a lot of really high-quality data, particularly from the general population and not just from centers of excellence, to help women understand what are some of the tradeoffs between their different options and how they’ll fair in the long term with regard to how they feel and how they function,” Smith, a professor of radiation oncology and health services research at The University of Texas MD Anderson Cancer Center in Houston, said in an interview with CURE®.

The different options, Smith highlighted, include a minimally invasive procedure such as a lumpectomy (a procedure to remove the cancer while preserving the appearance of the patient’s breast) followed by radiation treatment or a mastectomy (the complete removal of the affected breast) and complete reconstruction of the breast. However, Smith explained, little is known about a patient’s quality of life following either procedure.

Smith and colleagues obtained quality of life data in patients who underwent breast-conserving surgery combined with radiation therapy (551 patients) as well as those who underwent a mastectomy and reconstruction (236 patients) to determine if there were any major differences between the groups.

The results demonstrated that there were no significant differences in physical well-being between either patient group, which Smith described as “cosmetic satisfaction” — or, how a patient feels about how they look. Psychical functioning and decisional regret were also similar between the two groups.

However, psychosocial well-being (which Smith described as “how do you feel about yourself as a woman?”) and sexual well-being outcomes were significantly worse in patients who had a mastectomy and breast reconstruction.

Smith explained that some patients may feel worse in a sexual and psychosocial well-being sense because after a mastectomy and reconstruction, they may not feel like themselves. And although those who underwent breast-conserving surgery combined with radiation therapy might have an altered breast because of the treatment, the breast is still their own and not a foreign body such as an implant.

“If you have a mastectomy and a breast reconstruction, when you look in the mirror it may look pretty good, but it may not really feel like you,” Smith explained. “That reconstructed breast is numb, it doesn't have sensation. In many cases, there's an implant reconstruction so you have a foreign body in your body to reconstruct that breast. And so that just may not feel natural and it may not feel like it's a part of you.

“In contrast, if you have a lumpectomy and radiation, you keep your breasts, you keep the skin overlying your breast, (and) in almost all cases you keep your sensation,” he continued “And the breast, even if it may be altered a bit by the surgery or the radiation, still kind of feels like a normal part of your body. I think those fundamental differences are what explain some of these differences in outcome measures that we were able to report in our paper.”

He said that these data highlight that a patient with early-stage breast cancer should consult their providers to identify the least amount of surgery or treatment possible that has the best cure rate but also preserves their long-term quality of life. In this instance, radiation therapy preceded by a minimally invasive surgery that preserved the breast resulted in a better long-term quality of life, compared with a mastectomy and breast reconstruction.

“I think the overall message from our paper — and more broadly from the last few decades of research in early breast cancer — is that the less we do to patients, the better their long-term quality of life will be provided that we do enough to still give them a high chance of cure,” Smith concluded.

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