Does cosmetic outcome from treatment of primary breast cancer influence psychosocial morbidity?

AIMS To investigate any influence of cosmetic outcome on psychosocial morbidity in patients who have undergone breast-conserving surgery for primary breast cancer. METHODS Cosmetic outcome was assessed both objectively and subjectively in 254 patients, aged 20-69 years, who underwent breast-conserving surgery for operable primary breast cancer, </=3 cm in diameter; most women also received post-operative intact breast irradiation. Patients completed questionnaires assessing satisfaction with the outcome and assessing other psychosocial morbidity using the Hospital Anxiety Depression scale, the Body Image questionnaire and the Rosenberg Self-esteem scale. RESULTS Patient satisfaction was high (90.5% of the patients were very or moderately satisfied). There was an excellent correlation between cosmesis and levels of anxiety (r=-0.81, P<0.001) and depression (r=-0.7, P<0.001) and between cosmesis and body image (r=-0.4, P<0.001), sexuality (chi(2)=22, P=0.001) and self-esteem (r=-0.64, P<0.001). CONCLUSIONS This study has shown that the cosmetic result achieved has a marked bearing on the subsequent development of psychological outcome.

[1]  V. Mock.  Body Image in Women Treated For Breast Cancer , 1993, Nursing research.

[2]  R. Snaith,et al.  The Hospital Anxiety and Depression Scale , 1983 .

[3]  D. Ash,et al.  Seven-year follow-up on 334 patients treated by breast conserving surgery and short course radical postoperative radiotherapy: a report of the Yorkshire Breast Cancer Group. , 1995, Clinical oncology (Royal College of Radiologists (Great Britain)).

[4]  Penny Hopwood.  The assessment of body image in cancer patients. , 1993, European journal of cancer.

[5]  E. Touboul,et al.  Early breast cancer: influence of type of boost (electrons vs iridium-192 implant) on local control and cosmesis after conservative surgery and radiation therapy. , 1995, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[6]  I. Ellis,et al.  Safe selection criteria for breast conservation without radical excision in primary operable invasive breast cancer. , 1995, European journal of cancer.

[7]  R W Blamey,et al.  The cosmetic outcome in early breast cancer treated with breast conservation. , 1999, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[8]  Effects of breast conservation on psychological morbidity associated with diagnosis and treatment of early breast cancer. , 1986 .

[9]  L. Schover.  Sexuality and body image in younger women with breast cancer. , 1994, Journal of the National Cancer Institute. Monographs.

[10]  L. Fallowfield.  Psychosocial adjustment after treatment for early breast cancer. , 1990, Oncology.

[11]  J R Yarnold,et al.  Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer. 1. Comparison of patients' ratings, observers' ratings, and objective assessments. , 1992, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[12]  E. van der Schueren,et al.  Cosmetic evaluation of breast conserving treatment for mammary cancer. 1. Proposal of a quantitative scoring system. , 1989 .

[13]  S Hellman,et al.  Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. , 1979, International journal of radiation oncology, biology, physics.

[14]  J O Archambeau,et al.  Breast retraction assessment: an objective evaluation of cosmetic results of patients treated conservatively for breast cancer. , 1985, International journal of radiation oncology, biology, physics.