Dana-Farber Cancer Institute, Boston, Massachusetts.
Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Surg. 2020 Nov 1;155(11):1035-1042. doi: 10.1001/jamasurg.2020.3325.
Young women with breast cancer are increasingly choosing bilateral mastectomy (BM), yet little is known about short-term and long-term physical and psychosocial well-being following surgery in this population.
To evaluate the differential associations of surgery with quality of life (QOL) and psychosocial outcomes from 1 to 5 years following diagnosis.
DESIGN, SETTING, AND PARTICIPANTS: Cohort study.
Multicenter, including academic and community hospitals in North America.
Women age ≤40 when diagnosed with Stage 0-3 with unilateral breast cancer between 2006 and 2016 who had surgery and completed QOL and psychosocial assessments.
EXPOSURES (FOR OBSERVATIONAL STUDIES): Primary breast surgery including breast-conserving surgery (BCS), unilateral mastectomy (UM), and BM.
Physical functioning, body image, sexual health, anxiety and depressive symptoms were assessed in follow-up.
Of 826 women, mean age at diagnosis was 36.1 years; most women were White non-Hispanic (86.7%). Regarding surgery, 45% had BM, 31% BCS, and 24% UM. Of women who had BM/UM, 84% had reconstruction. While physical functioning, sexuality, and body image improved over time, sexuality and body image were consistently worse (higher adjusted mean scores) among women who had BM vs BCS (body image: year 1, 1.32 vs 0.64; P < .001; year 5, 1.19 vs 0.48; P < .001; sexuality: year 1, 1.66 vs 1.20, P < .001; year 5, 1.43 vs 0.96; P < .001) or UM (body image: year 1, 1.32 vs 1.15; P = .06; year 5, 1.19 vs 0.96; P = .02; sexuality: year 1, 1.66 vs 1.41; P = .02; year 5, 1.43 vs 1.09; P = .002). Anxiety improved across groups, but adjusted mean scores remained higher among women who had BM vs BCS/UM at 1 year (BM, 7.75 vs BCS, 6.94; P = .005; BM, 7.75 vs UM, 6.58; P = .005), 2 years (BM, 7.47 vs BCS, 6.18; P < .001; BM, 7.47 vs UM, 6.07; P < .001) and 5 years (BM, 6.67 vs BCS, 5.91; P = .05; BM, 6.67 vs UM, 5.79; P = .05). There were minimal between-group differences in depression levels in follow-up.
While QOL improves over time, young breast cancer survivors who undergo more extensive surgery have worse body image, sexual health, and anxiety compared with women undergoing less extensive surgery. Ensuring young women are aware of the short-term and long-term effects of surgery and receive support when making surgical decisions is warranted.
越来越多的年轻乳腺癌患者选择双侧乳房切除术（BM），但对于该人群手术后短期和长期的身体和心理社会健康状况知之甚少。
评估手术后与诊断后 1 至 5 年生活质量（QOL）和心理社会结局的差异相关性。
设计、地点和参与者：队列研究。
包括北美的学术和社区医院在内的多中心。
2006 年至 2016 年期间诊断为 0-3 期单侧乳腺癌且年龄≤40 岁的女性，进行了手术，并完成了 QOL 和心理社会评估。
暴露（观察性研究）：主要的乳房手术包括保乳手术（BCS）、单侧乳房切除术（UM）和 BM。
在随访中评估了身体功能、身体形象、性健康、焦虑和抑郁症状。
在 826 名女性中，平均诊断年龄为 36.1 岁；大多数女性为白种非西班牙裔（86.7%）。关于手术，45%的女性接受了 BM，31%的女性接受了 BCS，24%的女性接受了 UM。在接受 BM/UM 的女性中，84%接受了重建。虽然身体功能、性行为和身体形象随着时间的推移而改善，但与 BCS 相比，接受 BM 的女性的性行为和身体形象始终更差（调整后的平均得分更高）（身体形象：第 1 年，1.32 对 0.64；P <.001；第 5 年，1.19 对 0.48；P <.001；性健康：第 1 年，1.66 对 1.20，P <.001；第 5 年，1.43 对 0.96；P <.001）或 UM（身体形象：第 1 年，1.32 对 1.15；P =.06；第 5 年，1.19 对 0.96；P =.02；性健康：第 1 年，1.66 对 1.41；P =.02；第 5 年，1.43 对 0.96；P =.002）。焦虑在各组中均有所改善，但在第 1 年、第 2 年和第 5 年，接受 BM 的女性的调整后平均得分仍高于接受 BCS/UM 的女性（BM，7.75 对 BCS，6.94；P =.005；BM，7.75 对 UM，6.58；P =.005），第 2 年（BM，7.47 对 BCS，6.18；P <.001；BM，7.47 对 UM，6.07；P <.001）和第 5 年（BM，6.67 对 BCS，5.91；P =.05；BM，6.67 对 UM，5.79；P =.05）。在随访中，各组之间的抑郁水平差异很小。
虽然 QOL 随着时间的推移而改善，但接受更广泛手术的年轻乳腺癌幸存者的身体形象、性健康和焦虑状况比接受较少广泛手术的女性更差。确保年轻女性了解手术的短期和长期影响，并在做出手术决策时得到支持是合理的。
