Search

Background. Clinical trials comparing mastectomy to conservative surgery plus radiation therapy in the treatment of breast cancer have provided an opportunity to increase understanding of the biology of this disease and the psychological adaptation of the breast cancer patient. Because these local treatments appear to be equal in terms of survival, the question remains as to whether conservative surgery plus radiation therapy confers a measure of psychological comfort superior to that of mastectomy for women diagnosed with early-stage breast cancer. Methods. One hundred forty-two women participating in a clinical trial randomizing patients to mastectomy or lumpectomy and radiation therapy were prospectively evaluated for psychological response to their respective local therapy. A baseline assessment before randomization and subsequent questionnaires at 6, 12, and 24 months after treatment were completed by patients entered in the clinical trial. Results. At 6 months, mastectomy patients reported significantly less control over events in their lives (P = 0.003) and more problems with sexual relations (P = 0.021) than did their conservatively treated counterparts. In addition, there were marked differences between mastectomy patients and lumpectomy and radiation therapy patients in the degree of distress over their nude bodies, with P = 0.001 at 6 months, P = 0.019 at 12 months, and P = 0.057 at 24 months. Conclusions. From our findings, it appears that breast conservation therapy protects women's perception of their body but does not, over time, contribute to a more positive sexual adjustment. Cancer 1994; 73: 1221--8. Key words: breast cancer, conservative surgery, radiation therapy, surgical therapy, mastectomy, psychosocial studies.

About half of all patients with stage I or stage II breast cancer have metastatic spread of cancer to the axillary (armpit) lymph nodes. Excision of these nodes, routinely performed to remove metastasis, provides information on prognosis and used to select patients for chemo- and radiation therapy. The presence and number of metastatic lymph nodes is an indicator of prognosis. Axillary lymph node metastasis may be divided into three anatomic levels indicating their proximity to the pectoralis minor muscle of the upper chest wall. The prognostic value of the anatomic level of metastatic involvement remains controversial. A study was undertaken of 135 patients with breast cancer to determine the prognostic significance of the level of axillary node metastasis. Patients had stage I or stage II cancer and underwent either a modified radical mastectomy (removal of the breast) or lumpectomy (removal of the lump) with removal of axillary nodes and radiotherapy. Seventy-one patients had no axillary metastasis. The average patient follow-up was 6.9 years. It was found that there was no significant difference in survival or disease-free survival between patients whose highest level of metastasis was level I compared with patients whose highest level was level II. Patients with level III involvement did have significantly worse survival. However, when these patients were grouped by total number of metastatic lymph nodes, there was no difference in overall survival compared with patients with level I or level II involvement. These results show that for patients with stage II breast cancer, the level of node involvement is not an independent predictor of survival. (Consumer Summary produced by Reliance Medical Information, Inc.)