TYPE OF MASTECTOMY AND QUALITY-OF-LIFE FOR LONG-TERM BREAST-CARCINOMASURVIVORS

BACKGROUND. Despite numerous studies of partial mastectomy and psychol ogic morbidity in the first 24 months following surgery, little is kno wn about the long term psychosocial repercussions of partial and total mastectomy. METHODS. The effect of the type of mastectomy on psycholo gic adjustment was assessed among 124 breast carcinoma survivors, 47 o f whom underwent partial mastectomy and 77 of whom underwent total mas tectomy, 8 years after initial treatment. Interviews were also conduct ed 3 and 18 months after surgery. Psychologic distress was assessed us ing the Psychiatric Symptom Index. Other outcomes included physical sy mptoms, patients' perceptions of their own health, satisfaction with t he type of surgery performed and with the appearance of the scar, and marital and sexual adjustments. RESULTS. No statistically significant differences between partial and total mastectomy were observed with re spect to long term quality of life. Age at diagnosis modified the rela tion between the type of mastectomy and psychologic distress in both t he short term and the long term (P = 0.04). Among women younger than 5 0 years, partial mastectomy appeared to be protective against distress when compared with total mastectomy. In contrast, among women age 50 years or older, partial mastectomy was associated with higher psycholo gic distress levels at all interviews. CONCLUSIONS. Assessed globally, partial and total mastectomy appear to be equiv alent treatments in t erms of patients' long term quality of life. However, both short term and long term distress levels after partial and total mastectomy may d epend on patients' age at diagnosis. The findings of this study sugges t that the increased use of partial mastectomy may lessen the negative effects of breast carcinoma on younger survivors' quality of life. Ne vertheless, total mastectomy may bean appropriate initial treatment fo r some women who truly choose it. Cancer 1998;83: 2130-8. (C) 1998 Ame rican Cancer Society.