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Effects of breast cancer surgery and surgical side effects on body image over time

  • Epidemiology
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Abstract

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.

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References

  1. American Cancer Society (2007) Cancer facts & figures. American Cancer Society, Atlanta

    Google 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 34:307–314

    Article  CAS  PubMed  Google Scholar 

  3. de Haes J, Curran D, Aaronson N, Fentiman I (2003) Quality of life in breast cancer patients aged over 70 years, participating in the EORTC 10850 randomized clinical trial. Eur J Cancer 39(7):945–951

    Article  PubMed  Google Scholar 

  4. Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Holzel D (2004) Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study. Breast J 10(3):223–231

    Article  PubMed  Google Scholar 

  5. Fobair P, Stewart SL, Chang S, D’Onofrio C, Banks P, Bloom JR (2006) Body image and sexual problems in young women with breast cancer. Psychooncology 15(7):579–594

    Article  PubMed  Google Scholar 

  6. Ganz PA, Schag CA, Lee JJ, Polinsky ML, Tan SJ (1992) Breast conservation versus mastectomy: is there a difference in psychological adjustment or quality of life in the year after surgery? Cancer 69:1729–1738

    Article  CAS  PubMed  Google Scholar 

  7. Goldberg J, Scott R, Davidson P, Murray G, Stallard S, George W, Maguire G (1992) Psychological morbidity in the first year after breast surgery. Eur J Surg Oncol 18:327–331

    CAS  PubMed  Google Scholar 

  8. Hartl K, Janni W, Kastner R, Sommer H, Strobl B, Rack B, Stauber M (2003) Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients. Ann Oncol 14(7):1064–1071

    Article  CAS  PubMed  Google Scholar 

  9. Hopwood C, Haviland J, Mills J, Sumo G, Bliss J (2007) The impact of age and clinical factors on quality of life in early breast cancer: an analysis of 2208 woman recruited to the UK START Trial (Standardisation of Breast Radiotherapy Trial). Breast 16:241–251

    Article  PubMed  Google Scholar 

  10. Janni W, Rjosk D, Dimpfl T, Haertl K, Strobl B, Hepp F, Henke A, Bergauer F, Sommer H (2001) Quality of life influenced by primary surgical treatment for stage I-III breast cancer: Long-term follow-up of a matched-pair analysis. Ann Surg Oncol 8(6):542–548

    CAS  PubMed  Google Scholar 

  11. Janz NK, Mujahid MS, Lantz PM, Fagerlin A, Salem B, Morrow M, Deapen D, Katz SJ (2005) Population-based study of the relationships of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res 14:1467–1479

    Article  PubMed  Google Scholar 

  12. Kiebert GM, de Haes JCM, van de Velde CJH (1991) The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients. J Clin Oncol 9:1059–1070

    CAS  PubMed  Google Scholar 

  13. Kissane DW, Clarke DM, Ikin J, Bloch S, Smith GC, Vitetta L, McKenzie DP (1998) Psychological morbidity and quality of life in Australian women with early-staged breast cancer: a cross sectional survey. Med J Aust 169(4):192–196

    CAS  PubMed  Google Scholar 

  14. Kraus P (1999) Body image, decision making and breast cancer treatment. Cancer Nurs 22(6):421–427

    Article  CAS  PubMed  Google Scholar 

  15. Langer M, Prohaska R, Schreiner-Frech I, Ringler M, Kubista E (1991) Coping and body image after different operative techniques in breast cancer patients. Psychother Psychosom Med Psychol 41:379–384

    CAS  PubMed  Google Scholar 

  16. Lasry JCM, Margolese RG, Poisson R, Shibata H, Fleischer D, Lafleur D, Legault S, Taillefer S (1987) Depression and body image following mastectomy and lumpectomy. J Chron Dis 40:529–534

    Article  CAS  PubMed  Google Scholar 

  17. Mock V (1993) Body image in women treated for breast cancer. Nurs Res 42:153–157

    Article  CAS  PubMed  Google Scholar 

  18. Moyer A (1997) Psychosocial outcomes of breast-conserving surgery versus mastectomy: a meta-analytic review. Health Psychol 16:284–293

    Article  CAS  PubMed  Google Scholar 

  19. Nano MT, Grantly G, Kollias J, Bochner MA, Malycha P, Winefield HR (2005) Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg 75:940–947

    Article  PubMed  Google 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 54:260–266

    Article  CAS  PubMed  Google Scholar 

  21. Poulson B, Graversen HP, Beckmann J, Blichert-Toft M (1997) A comparative study of post-operative psychosocial function in women with primary operable breast cancer randomized to breast conservation therapy or mastectomy. Eur J Surg Oncol 23:327–334

    Article  Google Scholar 

  22. Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA (2000) Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92(17):1422–1429

    Article  CAS  PubMed  Google Scholar 

  23. Schover LR, Yetman RJ, Tuason LJ, Meisler E, Esselstyn CB, Hermann RE, Grundfest-Broniatowski S, Dowden RV (1995) Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality. Cancer 75(1):54–64

    Article  CAS  PubMed  Google Scholar 

  24. Wellisch DK, DiMatteo R, Silverstein M, Landsverk J, Hoffman R, Waisman J, Handel N, Waisman-Smith E, Schain W (1989) Psychosocial outcomes of breast cancer therapies: lumpectomy versus mastectomy. Pasychosomatics 30:365–373

    Article  CAS  Google Scholar 

  25. Carrera C, Payne S (1999) Ductal carcinoma in situ (DCIS) of the breast: the need for psychosocial research. Psychooncology 8:538–545

    Article  CAS  PubMed  Google 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 347:1233–1241

    Article  PubMed  Google Scholar 

  27. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232

    Article  PubMed  Google Scholar 

  28. Baxter NN, Virnig BA, Durham SB, Tuttle TM (2004) Trends in treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst 96:443–448

    Article  PubMed  Google Scholar 

  29. Schwartz GF, Solin LJ, Olivotto IA, Ernster VL, Pressman PI, Consensus Conference Committee (2000) Consensus conference on the treatment of in situ ductal carcinoma of the breast, April 22–25, 1999. Cancer 88:946–954

    Article  CAS  PubMed  Google Scholar 

  30. Morrow M, Strom E, Bassett L, Dershaw DD, Fowble B, Harris JR, O’Malley F, Schnitt SJ, Singletary SE, Winchester DP (2002) Standard for the management of ductal carcinoma in situ of the breast (DCIS). CA Cancer J Clin 52(5):256–276

    Article  PubMed  Google Scholar 

  31. Ernster VL, Barclay J, Kerlikowske K, Grady D, Henderson C (1996) Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 275:913–918

    Article  CAS  PubMed  Google Scholar 

  32. Parker PA, Youssef A, Walker S, Basen-Engquist K, Cohen L, Gritz E, Wei QX, Robb GL (2007) Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer. Ann Surg Oncol 14(11):3078–3089

    Article  PubMed  Google Scholar 

  33. Feig SA (2000) Ductal carcinoma in situ: implications for screening mammography. Radiol Clin North Am 38:653–668

    Article  CAS  PubMed  Google Scholar 

  34. Leitch AM, Dodd GD, Costanza M, Linver M, Pressman P, McGinnis L, Smith RA (1997) American Cancer Society Guidelines for the early detection of breast cancer: update 1997. CA Cancer J Clin 47:150–153

    Article  CAS  PubMed  Google Scholar 

  35. Smith RA, Mettlin CJ, Davis KJ, Eyre H (2000) American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin 50(1):34–49

    Article  CAS  PubMed  Google Scholar 

  36. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H (1983) Validation of a short Orientation-Memory-Concentration test of cognitive impairment. Am J Psychiatry 140:734–739

    Article  CAS  PubMed  Google Scholar 

  37. Schag CA, Ganz PA, Polinsky ML, Fred C, Hirji K, Petersen L (1993) Characteristics of women at risk for psychosocial distress in the year after breast cancer. J Clin Oncol 11:783–793

    CAS  PubMed  Google Scholar 

  38. Wapnir IL, Cody RP, Greco RS (1999) Subtle differences in quality of life after breast cancer surgery. Ann Surg Oncol 6:359–366

    Article  CAS  PubMed  Google Scholar 

  39. Katz JN, Chang LC, Sangha O, Fossel AH, Bates DW (1996) Can comorbidity be measured by questionnaire rather than medical record review? Med Care 34(1):73–84

    Article  CAS  PubMed  Google Scholar 

  40. Charlson ME, Pompei P, Ales K, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  41. Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 56:893–897

    Article  CAS  PubMed  Google Scholar 

  42. Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google 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 177–187

    Google Scholar 

  44. Lautenschlager GJ (1989) A comparison of alternatives to conducting Monte Carlo analyses for determining parallel analysis criteria. Multivariate Behav Res 24(3):365–395

    Article  CAS  PubMed  Google Scholar 

  45. Velicer WF (1976) Determining the number of components form the matrix of partial correlations. Psychometrika 41(3):321

    Article  Google Scholar 

  46. Olsen M, Lefta M, Dietz J, Brandt KE, Aft R, Matthews P, Mayfield J, Fraser VJ (2008) Risk factors for surgical site infection after major breast operation. J Am Coll Surg 207(3):326–335

    Article  PubMed  PubMed Central  Google Scholar 

  47. Olsen MA, Chu-Ongsakul S, Brandt KE, Dietz JR, Mayfield J, Fraser VJ (2008) Hospital-associated costs due to surgical site infection after breast surgery. Arch Surg 143(1):53–60

    Article  PubMed  Google Scholar 

  48. El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W (2007) Morbidity and mortality following breast cancer surgery in women. Ann Surg 245(5):665–671

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

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.

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Authors and Affiliations

  1. Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, 4444 Forest Park, Suite 6700, St. Louis, MO, 63108, USA

    Karen Kadela Collins, Mario Schootman & Donna B. Jeffe

  2. Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA

    Karen Kadela Collins, Mario Schootman, Rebecca Aft, Yan Yan & Donna B. Jeffe

  3. Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO, 63110, USA

    Ying Liu, Rebecca Aft & Yan Yan

  4. John Cochran Veterans Administration Hospital, St. Louis, MO, USA

    Rebecca Aft

  5. Department of Psychiatry and Behavioral Sciences, UC Davis Health System, 2230 Stockton Blvd., Sacramento, CA, 95817, USA

    Grace Dean

  6. Department of Surgery, Southern Illinois University School of Medicine, Carbondale, IL, USA

    Mark Eilers

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  1. Karen Kadela Collins
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Correspondence to Karen Kadela Collins.

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Collins, K.K., Liu, Y., Schootman, M. et al. Effects of breast cancer surgery and surgical side effects on body image over time. Breast Cancer Res Treat 126, 167–176 (2011). https://doi.org/10.1007/s10549-010-1077-7

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