Breast cancer in young women: bilateral mastectomy is tied to worse body image, sexuality than BCS

  • Rosenberg SM & al.
  • JAMA Surg
  • 16 Sep 2020

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Bilateral mastectomy (BM) was associated with worse body image, sexuality, and anxiety over a 5-year period postdiagnosis than breast-conserving surgery (BCS) in young women (age, ≤40 years) with stage 0-III unilateral breast cancer.

Why this matters

  • Young women increasingly prefer BM.
  • Findings from this cohort should be shared with women considering surgical options.

Study design

  • Prospective, multicenter cohort in North America (N=826).
  • Body image and sexual health studied yearly over the course of 5 years with subscales of the Cancer Rehabilitation Evaluation System Short Form, with higher scores indicating worse outcomes.
  • Anxiety studied by the Hospital Anxiety and Depression Scale (higher scores indicated worse outcomes).
  • Funding: Agency for Healthcare Research and Quality; others.

Key results

  • Body image and sexual health improved over time, but adjusted mean scores remained consistently worse for BM vs BCS:
    • Body image:
      • Year 1: 1.32 vs 0.64 (P<.001>
      • Year 5: 1.19 vs 0.48 (P<.001>
    • Sexuality:
      • Year 1: 1.66 vs 1.20 (P<.001>
      • Year 5: 1.43 vs 0.96 (P<.001.>
  • Results were similar for BM vs unilateral mastectomy (UM).
  • Anxiety improved over time, but adjusted mean scores remained higher among women with BM vs BCS/UM:
    • 1 year:
      • 7.75 vs 6.94 for BCS (P=.03).
      • 7.75 vs 6.58 for UM (P=.005).
    • 5 years:
      • 6.67 vs 5.91 for BCS (P=.05).
      • 6.67 vs 5.79 for UM (P=.05).

Limitations

  • Observational design.