Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
Department of Surgery, Women's College Hospital, Toronto, ON, Canada.
Ann Surg Oncol. 2021 Oct;28(11):5985-5998. doi: 10.1245/s10434-021-09928-6. Epub 2021 Apr 5.
Rates of bilateral mastectomy are rising in women with unilateral, nonhereditary breast cancer. We aim to characterize how psychosocial outcomes evolve after breast cancer surgery.
We performed a prospective cohort study of women with unilateral, sporadic stage 0-III breast cancer at University Health Network in Toronto, Canada between 2014 and 2017. Women completed validated psychosocial questionnaires (BREAST-Q, Impact of Event Scale, Hospital Anxiety & Depression Scale) preoperatively, and at 6 and 12 months following surgery. Change in psychosocial scores was assessed between surgical groups using linear mixed models, controlling for age, stage, and adjuvant treatments. P < .05 were significant.
A total of 475 women underwent unilateral lumpectomy (42.5%), unilateral mastectomy (38.3%), and bilateral mastectomy (19.2%). There was a significant interaction (P < .0001) between procedure and time for breast satisfaction, psychosocial and physical well-being. Women having unilateral lumpectomy had higher breast satisfaction and psychosocial well-being scores at 6 and 12 months after surgery compared with either unilateral or bilateral mastectomy, with no difference between the latter two groups. Physical well-being declined in all groups over time; scores were not better in women having bilateral mastectomy. While sexual well-being scores remained stable in the unilateral lumpectomy group, scores declined similarly in both unilateral and bilateral mastectomy groups over time. Cancer-related distress, anxiety, and depression scores declined significantly after surgery, regardless of surgical procedure (P < .001).
Psychosocial outcomes are not improved with contralateral prophylactic mastectomy in women with unilateral breast cancer. Our data may inform women considering contralateral prophylactic mastectomy.
在患有单侧非遗传性乳腺癌的女性中，双侧乳房切除术的比例正在上升。我们旨在描述乳腺癌手术后心理社会结局的演变。
我们在加拿大多伦多大学健康网络进行了一项前瞻性队列研究，纳入了 2014 年至 2017 年间患有单侧、散发性 0-III 期乳腺癌的女性。女性在术前以及术后 6 个月和 12 个月时完成了经过验证的心理社会问卷（BREAST-Q、事件影响量表、医院焦虑和抑郁量表）。使用线性混合模型评估手术组之间的心理社会评分变化，控制年龄、分期和辅助治疗。P<.05 为有统计学意义。
共有 475 名女性接受了单侧乳房切除术（42.5%）、单侧乳房切除术（38.3%）和双侧乳房切除术（19.2%）。手术方法和时间对乳房满意度、心理社会和身体幸福感存在显著的交互作用（P<.0001）。与单侧乳房切除术或双侧乳房切除术相比，接受单侧乳房切除术的女性在术后 6 个月和 12 个月时乳房满意度和心理社会幸福感评分更高，而后两组之间没有差异。所有组的身体幸福感随着时间的推移而下降；双侧乳房切除术组的评分并没有更好。尽管单侧乳房切除术组的性功能评分保持稳定，但随着时间的推移，单侧和双侧乳房切除术组的评分下降相似。无论手术方式如何，手术后癌症相关的困扰、焦虑和抑郁评分均显著下降（P<.001）。
在患有单侧乳腺癌的女性中，对侧预防性乳房切除术并不能改善心理社会结局。我们的数据可能为考虑对侧预防性乳房切除术的女性提供信息。
