A new study has reported that women undergoing breast conserving treatment for breast cancer can experience a number of ongoing side effects. Breast conserving therapy is designed to avoid mastectomy by using a combination of lumpectomy or partial mastectomy and radiation treatment. The study was designed to investigate cosmetic outcomes and persistent side effects of breast conserving treatment. Previous studies have reported “excellent” or “good” cosmesis (i.e., the preservation, restoration, or enhancement of physical appearance) in over 90% of women treated using breast conservation.
To conduct the study, self-reported patient data was collected using a free, publically available, internet-based tool for the creation of breast cancer survivorship care plans. While using the tool, survivors were questioned as to the cosmetic appearance of their treated breasts, as well as perceived late effects or complications of their cancer treatment. All collected data was maintained anonymously. The study included 354 women with median age 48 at diagnosis and 52 years at data collection.
“Excellent” cosmesis was reported by 88 (27%) of the study participants, “Good” by 144 (44%), “Fair” by 81 (24%), and “Poor” by 18 (5%). Late effects of breast cancer treatment included (1) cognitive changes ("chemo brain") (62%); (2) sexual concerns (52%); (3) changes in the texture or color of irradiated skin (48%); (4) chronic pain, numbness, or tingling (35%); (5) osteopenia or osteoporosis (35%); (6) loss of flexibility in the irradiated area (30%); (7) lymphedema (19%); and (8) cardiopulmonary problems (12%). The authors comment that cosmetic assessment by survivors having undergone breast conserving treatment appears less likely to be “excellent” or “good” than would be expected based on previous studies, with 30% of breast conserving treatment survivors reporting “fair” or “poor” cosmesis. Study participants also reported significant rates chronic pain, as well as cognitive and sexual changes.
Comments regarding the study
The relatively high rates of ongoing side effects of breast cancer treatment (which included chemotherapy and/or endocrine treatment for some of the women) can be explained in part by the fact that the study participants were not a random sample of survivors. The median age was lower, including a higher proportion of premenopausal women, than the general breast cancer population. More importantly, the women were self-motivated to seek out and develop a personalized survivorship plan. This made them less likely to be among the fortunate minority of early-stage breast cancer survivors for whom lumpectomy and radiation are a striking but temporary event from which they can quickly recover both physically and psychologically. However, the study results are still interesting since they provide a ranking of common treatment effects persisting at a median of four years after diagnosis.