title: Surgical options for the early-stage breast cancer: factors associated with patient choice and postoperative quality of life.
abstract: Patients with early-stage breast cancer have three surgical options: lumpectomy with radiotherapy, mastectomy alone, and mastectomy with breast reconstruction. Our objective was to compare women in these three groups with respect to demographics, preoperative counseling, postoperative body image, and quality of life. Women having undergone surgery for stage 1 or 2 breast cancer between 1990 and 1995 were selected by random sampling of hospital tumor registries and were mailed a self-administered questionnaire, which included the Medical Outcomes Survey Short Form 36. Patients were stratified into three mutually exclusive groups: lumpectomy with axillary node dissection and radiotherapy, modified radical mastectomy, and modified radical mastectomy with breast reconstruction. In total, 267 of 525 surveys were returned (50.9 percent). Compared with mastectomy patients, breast reconstruction patients were younger (p < 0.001), better educated (p = 0.001), and more likely Caucasian (p = 0.02). Among mastectomy patients, 54.9 percent recalled that lumpectomy had been discussed preoperatively and 39.7 percent recalled discussion of breast reconstruction. Post-operative comfort with appearance was significantly lower for mastectomy patients. The relationship between type of surgery and postoperative quality of life varied with age. Under 55, quality of life was lowest for mastectomy patients on all but two Medical Outcomes Survey Short Form 36 subscales. Over 55, quality of life was lowest for lumpectomy patients on all subscales (p < 0.05 for all subscales except social functioning and role-emotional). Treatment choice may be related to age, race, education, and preoperative counseling. Whereas the effect of breast cancer on a woman's life is complex and individual, the type of surgery performed is a significant variable, whose impact may be related to patient age.
authors.affiliation: Division of Plastic Surgery at The Johns Hopkins University, Baltimore, MD, USA.
authors.forename: A
authors.initials: A
authors.lastname: Pusic
authors.forename: T A
authors.initials: TA
authors.lastname: Thompson
authors.forename: C L
authors.initials: CL
authors.lastname: Kerrigan
authors.forename: R
authors.initials: R
authors.lastname: Sargeant
authors.forename: S
authors.initials: S
authors.lastname: Slezak
authors.forename: B W
authors.initials: BW
authors.lastname: Chang
authors.forename: K J
authors.initials: KJ
authors.lastname: Kelzlsouer
authors.forename: P N
authors.initials: PN
authors.lastname: Manson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001828:Body Image; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D003131:Combined Modality Therapy; D003376:Counseling; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D016462:Mammaplasty; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011788:Quality of Life; D011795:Surveys and Questionnaires