BREAST-CANCER IN WESTERN-AUSTRALIA IN 1989 .5. OUTCOME AT 5 YEARS AFTER DIAGNOSIS

Background: A follow-up study was undertaken of all Western Australian women who had a new diagnosis of boast cancer during 1989. The aims w ere to determine survival, frequency of recurrence and quality of life (QoL) of Western Australian women 5 years after a diagnosis of breast cancer; to determine reasons for choice ol rejection of reconstructiv e surgery in those women treated by mastectomy, and to determine if th e choice of lumpectomy or mastectomy affects subsequent QoL. Methods: The vital status as at Ist June 1994 of all 692 women who had a new di agnosis of breast cancer in 1989 was ascertained by electronic linkage to official mortality registrations. A subsample of 215 survivors who had originally been treated by the nine surgeons who had managed 20 o r more cases each was sent a reply-paid postal questionnaire asking ab out follow-up treatment since diagnosis, recurrence of disease, curren t QoL and attitudes to, and use of, reconstructive surgery. Results: T he overall survival rate at 5 years was 80.8% (85.9% and 78.8% for Sta ge I and II, respectively). Cumulative mortality was 35% lower among t he third of patients treated by the nine most active surgeons (14% vs 22%, P < 0.02), but this may be subject to referral bias. The subsampl e was representative of all surviving cases except for being an averag e of 2.7 years younger at diagnosis (mean ages 55.2 and 57.9 years). T he response rate of the subsample to the postal questionnaire was 78%. Of women who had had a mastectomy. 40% had considered having a recons truction, but only nine (78%) had undergone this operation. Median QoL on the Rosser scale (maximum = 1.0) was 0.9. QoL was worse for the 23 % of patients with a recurrence of breast cancer. Patients treated by breast-conserving surgery showed a trend toward a better QoL compared with those treated by mastectomy. Conclusion: At 5 years after the dia gnosis of breast cancer, one in five women had died and an estimated o ne in four of the survivors had recurrent disease. Quality of life in the remaining patients, half of whom had undergone adjuvant treatment, was very good. These are important baseline data against which to jud ge the impact of mammographic screening.