Surgical options for early-stage breast cancer: Factors associated with patient choice and postoperative quality of life

Patients with early-stage breast cancer have three surgical options: lumpec tomy with radiotherapy, mastectomy alone, and mastectomy with breast recons truction. Our objective was to compare women in these three groups with res pect to demographics, preoperative counseling, postoperative body image, an d quality of life. Women having undergone surgery for stage 1 or 2 breast cancer between 1990 and 1995 were selected by random sampling of hospital tumor registries and were mailed a self-administered questionnaire, which included the Medical O utcomes Survey Short Form 36. Patients were stratified into three mutually exclusive groups: lumpectomy with axillary node dissection and radiotherapy , modified radical mastectomy, and modified radical mastectomy with breast reconstruction. In total, 267 of 525 surveys were returned (50.9 percent). Compared with ma stectomy patients, breast reconstruction patients were younger (p < 0.001), better educated (p = 0.001), and more likely Caucasian (P = 0.02). Among m astectomy patients, 54.9 percent recalled that lumpectomy had been discusse d preoperatively and 39.7 percent recalled discussion of breast reconstruct ion. Postoperative comfort with appearance was significantly lower for mast ectomy patients. The relationship between type of surgery and postoperative quality of life varied with age. Under 55, quality of life was lowest for mastectomy patients on all but two Medical Outcomes Survey Short Form 36 su bscales. Over 55, quality of life was lowest for lumpectomy patients on all subscales (p < 0.05 for all subscales except social functioning and role-e motional). Treatment choice may be related to age, race, education, and preoperative c ounseling. Whereas the effect of breast cancer on a woman's life is complex and individual, the type of surgery performed is a significant variable, w hose impact may be related to patient age.