LONG-TERM SEQUELAE OF BREAST-CANCER SURGERY

Background: Quality of care is today a major issue in oncology, and mu ch attention is given to research on the outcome of breast cancer care . Too little attention has been devoted in the scientific literature t o the consequences of treatment in long-term survivors, and in particu lar to the possible side effects, The specific aim of this contributio n is to present population-based data about the long-term impact of br east cancer care in women who had an incident cancer in 1985/1986. Pat ients and Methods: The cases are 476 breast cancers incident in the Ci ty of Florence in 1985-86. Women still living 5 years later were invit ed to have an interview and a physical examination, Lymphedema, periph eral nerve lesions and damage to the shoulder were assessed. Results: Of the 346 5-year survivors, 238 accepted our invitation: 35.2% of the women reported some early postoperative sequelae, 30.2% had a chronic lymphedema and 18.9% a shoulder deficit. Comparing breast-conserving surgery with radical mastectomy, the risk of chronic lymphedema (OR=1. 62; 95% Cl: 0.91-2.88) and other lesions was higher for women who had a radical surgery, Women who had a breast-conserving surgery more ofte n reported an early lymphedema (OR=1.60; 95% Cl: 0.88-2.88). Conclusio ns: The proportion of women who complained of (or manifested at the ph ysical examination) a minor or major disability of the arm in our stud y was high. The impact of these functional problems in terms of qualit y of life should also be assessed, but it is our impression that there is need for much greater attention to the issue of long-term survivor sequelae.