Post-surgery breast asymmetry linked to worse QOL

By Anne Harding

NEW YORK (Reuters Health) - The symmetry of a woman's breasts after she undergoes lumpectomy to treat breast cancer can have a major impact on her quality of life, new research suggests.

Women left with pronounced asymmetry after breast-conserving surgery were more than four times as likely to feel stigmatized as a result of their treatment, about twice as likely to fear that their cancer would return, and more likely to have symptoms of depression than women with only mild to moderate breast asymmetry, Dr. Jennifer F. Waljee of the University of Michigan in Ann Arbor and her colleagues found.

"Breast asymmetry may be a constant reminder to these patients of their disease and treatment process, impairing their psychological adjustment after treatment," Waljee and her team suggest in their report. "While we can not determine if asymmetry causes these effects, this is a possible mechanism underlying the associations we found," the researcher added in an interview with Reuters Health.

While breast-conserving surgery is thought to be the least disfiguring surgical option for cancer treatment, Waljee and her team note in the Journal of Clinical Oncology, most women have some degree of breast asymmetry after the surgery. And while mastectomy patients are typically told about the option of breast reconstruction surgery before they undergo the operation, they add, this option may not be a standard part of the pre-surgery discussion for lumpectomy patients.

To investigate how the appearance of a woman's breasts after surgery might affect her well-being, the researchers surveyed 714 women who underwent breast-conserving surgery at their center over a 4-year period.

Overall, 17.8 percent of the women said they felt stigmatized by their surgery, about 27 percent had high levels of fear, and 22 percent had symptoms of depression. Just 5.6 percent said their health had improved since their breast cancer diagnosis, while 33.1 percent said it had gotten worse and 61.3 percent said their health hadn't changed.

Among women with pronounced asymmetry, 33.7 percent had depressive symptoms, and 40.4 percent had high levels of fear about issues such as death, their health, or their inability to fulfill their roles.

Among women with minimal asymmetry, 16.2 percent had depressive symptoms and 19.8 percent had high levels of fear; the corresponding percentages for women with moderate asymmetry were 18 percent and 19 percent, respectively.

Women with pronounced asymmetry were also 67 percent less likely to say their health had stayed the same or improved after their diagnoses, and 4.58 times more likely to say they felt stigmatized due to their breast cancer treatment.

Women who undergo lumpectomy are often candidates for reconstructive surgery, Waljee noted. However, since most undergo radiation after the surgery, this may mean more complex reconstruction options are required.

"I think it's important for women to discuss all options with their surgeon at the time of decision making, both lumpectomy and mastectomy and options for reconstruction for both," she said. "The most important thing is that they have realistic expectations of what they are going to go through during treatment and what their postoperative recovery and ultimate outcome will be."

Studies have shown, Waljee noted, that the more closely a woman's experience with breast cancer surgery matches her expectations, the better she will feel about the outcome.

SOURCE: Journal of Clinical Oncology, July 10, 2008.