Effects of breast cancer surgery and surgical side effects on body image over time
We examined the impact of surgical treatments (breast-conserving surgery [BCS], mastectomy alone, mastectomy with reconstruction) and surgical side-effects severity on early stage (0–IIA) breast cancer patients’ body image over time. We interviewed patients at 4–6 weeks (T1), six (T2), 12 (T3), and 24 months (T4) following definitive surgical treatment. We examined longitudinal relationships among body image problems, surgery type, and surgical side-effects severity using the Generalized Estimating Equation approach, controlling for demographic, clinical, and psychosocial factors. We compared regression coefficients of surgery type from two models, one with and one without surgical side-effects severity. Of 549 patients enrolled (mean age 58; 75% White; 65% BCS, 12% mastectomy, 23% mastectomy with reconstruction), 514 (94%) completed all four interviews. In the model without surgical side-effects severity, patients who underwent mastectomy with reconstruction reported poorer body image than patients who underwent BCS at T1–T3 (each P < 0.02), but not at T4. At T2, patients who underwent mastectomy with reconstruction also reported poorer body image than patients who underwent mastectomy alone (P = 0.0106). Adjusting for surgical side-effects severity, body image scores did not differ significantly between patients with BCS and mastectomy with reconstruction at any interview; however, patients who underwent mastectomy alone had better body image at T2 than patients who underwent mastectomy with reconstruction (P = 0.011). The impact of surgery type on body image within the first year of definitive surgical treatment was explained by surgical side-effects severity. After 2 years, body image problems did not differ significantly by surgery type.
KeywordsBody image Breast cancer Psychosocial factors Quality of life Surgical side effects Surgery type
This study was supported by a Grant from the National Cancer Institute and Breast Cancer Stamp Fund (R01 CA102777) to Dr. Jeffe and by the National Cancer Institute Cancer Center Support Grant (P30 CA91842) to the Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, Missouri. We thank our patient participants, the interviewers, and the Siteman Cancer Center’s Health Behavior, Communication and Outreach Core and Biostatistics Core for data management and statistical services. We also thank the physicians who helped us recruit their patients for this study, including Drs. Barbara Monsees, Jill Dietz, Julie Margenthaler, Virginia Herrmann, Timothy Eberlein, Matthew Ellis, Imran Zoberi, Marie Taylor, Michael Naughton, Antonella Rastelli, Donald Lombardi, Cynthia Ma, Loren Michel, and Rama Suresh at Washington University School of Medicine and Dr. Eddie Hsueh and Pam Hunborg, RN, at Saint Louis University School of Medicine. The Beck Anxiety Inventory® and BAI® (copyright 1990, 1993 by Aaron T. Beck) are trademarks of The Psychological Corporation, a Harcourt Assessment Company. The BAI® was adapted and used by permission of the publisher, The Psychological Corporation. All rights reserved.
- 1.American Cancer Society (2007) Cancer facts & figures. American Cancer Society, AtlantaGoogle Scholar
- 2.Curran D, van Dongen JP, Aaronson NK, Kiebert G, Fentiman IS, Mignolet F, Bartelink H, on behalf of the European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG) (1998) Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. Eur J Cancer 34:307–314CrossRefPubMedGoogle Scholar
- 20.Noguchi M, Kitagawa H, Kinoshita K, Earashi M, Miyazaki I, Tatsukuchi S, Saito Y, Mizukami Y, Nonmura A, Nakamura S et al (1993) Psychologic and cosmetic self-assessments of breast conserving therapy compared with mastectomy and immediate breast reconstruction. J Surg Oncol 54:260–266CrossRefPubMedGoogle Scholar
- 26.Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized study comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241CrossRefPubMedGoogle Scholar
- 43.Radloff LS, Locke BZ (1986) The community mental health assessment survey and CES-D Scale. In: Weissman MM, Myers JK, Ross CE (eds) Community surveys of psychiatric disorders. Rutgers University Press, New Brunswick, pp 177–187Google Scholar