Ductal carcinoma in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image.
OBJECTIVE
To investigate and compare long-term health-related quality of life (HRQoL), body image, and emotional reactions in women with ductal carcinoma in situ of the breast (DCIS) treated with different surgical methods.


METHODS
A total of 162 women were included in the study (47 had mastectomy and immediate breast reconstruction (IBR), 51 sector resection alone and 64 sector resection and postoperative radiotherapy). All women included in the study were asked to complete three questionnaires 4-15 years after surgery: the SF-36 for HRQoL, the Hospital Anxiety and Depression (HAD) scale, and the Body Image Scale (BIS). The response rate was 81%.


RESULTS
Women in all three study groups had, overall, a very satisfactory HRQoL in the long term, similar to women in the general population. Women who underwent mastectomy and IBR scored significantly higher on physical functioning and bodily pain than the other two study groups as well as their age-adjusted norm groups. The addition of radiotherapy to breast-conserving therapy did not seem to have any negative impact on long-term HRQoL. Our results show significant differences between the three study groups for six of ten BIS items, with a greater proportion of women in the mastectomy and IBR group reporting problems.


CONCLUSIONS
Women treated for DCIS have a very satisfactory long-term HRQoL. However, body image appeared to be negatively affected in mastectomy and IBR patients. Our results indicate that these women need more preoperative information about what changes in body image to expect after surgery.
Sackey
H
H
Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, P9:03, 171 76 Stockholm, Sweden. helena.sackey@ki.se
Sandelin
K
K
Frisell
J
J
Wickman
M
M
Brandberg
Y
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001828:Body Image; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000523:psychology* / Q000601:surgery*; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D016462:Mammaplasty / Q000523:psychology; D015411:Mastectomy, Modified Radical / Q000523:psychology; D015412:Mastectomy, Segmental; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D011795:Surveys and Questionnaires; D013997:Time Factors