I came across the following article the other day and could identify with the feelings of those women who were disappointed with the results of their breast-conserving treatments for breast cancer.
Reprint of article in 2011 Current Cancer
A third of all breast cancer survivors who received the breast-conserving treatments of lumpectomy and radiation rate the appearance of their post-treatment breast as only fair or poor in comparison to their untreated breast, according to a new University of Pennsylvania School of Medicine study recently presented at the 52nd Annual Meeting of the American Society for Radiation Oncology (ASTRO) in San Diego.
The findings, which are the first to examine patients’ own impressions of the cosmetic appearance of their breasts following treatment, contrast with previous studies in which clinicians were more likely to label post-treatment breasts as good to excellent in appearance. The authors say that the findings shed light on how patients’ treatment expectations may differ from their physicians, and reveal a need for additional patient education about potential outcomes.
“Most patients’ are ultimately happy they were able to preserve their breasts, but our study shows that often, how they feel about the way they look after treatment is not as good as doctors would have predicted,” says lead author Christine Hill-Kayser, MD, an assistant professor of Radiation Oncology at Penn’s Abramson Cancer Center.
Among 503 patients surveyed who had a lumpectomy followed by radiotheraphy, the findings showed that 16 percent reported excellent cosmesis, 52 percent good, 30 percent fair, and 2 percent poor. Forty three percent of women who had these breast-conserving treatment reported chronic skin or soft tissue changes, 22 percent said they had chronic pain in the breast or arm, 21percent had suffered a loss of arm or shoulder flexibility, and 8 percent had chronic swelling.
The study data was collected from patients who voluntarily created an online survivorship care plan using the LIVESTRONG Care Plan Powered by Penn Medicine’s Oncolink (http://www.livestrongcareplan.org).
This easy to use tool developed by physicians and nurses from the Abramson Cancer Center, provides users with a road map for managing their health as they finish treatment and transition to life as a cancer survivor.
Currently, more than half of breast cancer patients undergo both lumpectomy and radiation, a combination of treatments which offer the best chance of cure while avoiding complete removal of the breast among women with stage I and stage II cancer.
Cosmetic issues that these patients may report include scarring , skin puckering, changes in the color and texture of the skin, size or shaped asymmetry between the treated and untreated breast, and nipple distortion. Although it may not be possible to correct all of these problems, Hill-Kayser notes there are a variety of therapies available for women with treatment complications, including physical therapy and weight training regimens for patients who experience the painful arm-swelling condition called lymphedema, and shoulder pain or stiffening.
“As cure rates for breast and other cancers continue to improve, attention to survivorship issues is more important than ever before,” Hill-Kayer says. “Understanding more about the way that survivors feel after their treatment is one step towards helping patients live as well as possible after cancer.”
I agree that physicians need to share more about what the patient may experience following breast-conserving surgery prior to the patient beginning treatment.
I was not prepared for the marked difference between the size and shape of the treated breast compared to the untreated breast. As the years went on and the untreated breast aged, the treated breast didn’t, which only added to the marked difference between the two. Within two years of treatment, I needed to wear a partial prosthesis in order to look balanced in my clothing.
I don’t know that it would have changed my decision to go with breast conserving surgery, but at least I would have been better prepared to handle my expectations.