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Research Article| Volume 36, ISSUE 8, P756-762, August 2010

Ductal carcinoma in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image

      Abstract

      Aims

      To investigate and compare long-term health-related quality of life (HRQoL), body image, and emotional reactions in women with ductal carcinoma in situ of the breast (DCIS) treated with different surgical methods.

      Patients and Methods

      A total of 162 women were included in the study (47 had mastectomy and immediate breast reconstruction (IBR), 51 sector resection alone and 64 sector resection and postoperative radiotherapy). All women included in the study were asked to complete three questionnaires 4–15 years after surgery: the SF-36 for HRQoL, the Hospital Anxiety and Depression (HAD) scale, and the Body Image Scale (BIS). The response rate was 81%.

      Results

      Women in all three study groups had, overall, a very satisfactory HRQoL in the long term, similar to women in the general population. Women who underwent mastectomy and IBR scored significantly higher on physical functioning and bodily pain than the other two study groups as well as their age-adjusted norm groups. The addition of radiotherapy to breast-conserving therapy did not seem to have any negative impact on long-term HRQoL. Our results show significant differences between the three study groups for six of ten BIS items, with a greater proportion of women in the mastectomy and IBR group reporting problems.

      Conclusions

      Women treated for DCIS have a very satisfactory long-term HRQoL. However, body image appeared to be negatively affected in mastectomy and IBR patients. Our results indicate that these women need more preoperative information about what changes in body image to expect after surgery.

      Keywords

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      References

        • The National Board of Health and Welfare
        National guidelines for breastcancer healthcare. Medical and healtheconomic document.
        The National Board of Health and Welfare, Stockholm2007
        • Julien J.P.
        • Bijker N.
        • Fentiman I.S.
        • et al.
        Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group.
        Lancet. 2000; 355: 528-533
        • Holmberg L.
        • Garmo H.
        • Granstrand B.
        • et al.
        Absolute risk reductions for local recurrence after postoperative radiotherapy after sector resection for ductal carcinoma in situ of the breast.
        J Clin Oncol. 2008; 26: 1247-1252
        • Emdin S.O.
        • Granstrand B.
        • Ringberg A.
        • et al.
        SweDCIS: radiotherapy after sector resection for ductal carcinoma in situ of the breast. Results of a randomised trial in a population offered mammography screening.
        Acta Oncol. 2006; 45: 536-543
        • Fisher B.
        • Costantino J.
        • Redmond C.
        • et al.
        Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer.
        N Engl J Med. 1993; 328: 1581-1586
        • Fisher B.
        • Dignam J.
        • Wolmark N.
        • et al.
        Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17.
        J Clin Oncol. 1998; 16: 441-452
        • Houghton J.
        • George W.D.
        • Cuzick J.
        • Duggan C.
        • Fentiman I.S.
        • Spittle M.
        Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial.
        Lancet. 2003; 362: 95-102
        • Warnberg F.
        • Bergh J.
        • Holmberg L.
        Prognosis in women with a carcinoma in situ of the breast: a population-based study in Sweden.
        Cancer Epidemiol Biomarkers Prev. 1999; 8: 769-774
        • Innos K.
        • Horn-Ross P.L.
        Risk of second primary breast cancers among women with ductal carcinoma in situ of the breast.
        Breast Cancer Res Treat. 2008; 111: 531-540
        • Franceschi S.
        • Levi F.
        • La Vecchia C.
        • Randimbison L.
        • Te V.C.
        Second cancers following in situ carcinoma of the breast.
        Int J Cancer. 1998; 77: 392-395
        • De Morgan S.
        • Redman S.
        • White K.J.
        • Cakir B.
        • Boyages J.
        “Well, have I got cancer or haven’t I?" The psycho-social issues for women diagnosed with ductal carcinoma in situ.
        Health Expect. 2002; 5: 310-318
        • Kennedy F.
        • Harcourt D.
        • Rumsey N.
        The challenge of being diagnosed and treated for ductal carcinoma in situ (DCIS).
        Eur J Oncol Nurs. 2008; 12: 103-111
        • Bluman L.G.
        • Borstelmann N.A.
        • Rimer B.K.
        • Iglehart J.D.
        • Winer E.P.
        Knowledge, satisfaction, and perceived cancer risk among women diagnosed with ductal carcinoma in situ.
        J Womens Health Gend Based Med. 2001; 10: 589-598
        • Partridge A.
        • Adloff K.
        • Blood E.
        • et al.
        Risk perceptions and psychosocial outcomes of women with ductal carcinoma in situ: longitudinal results from a cohort study.
        J Natl Cancer Inst. 2008; 100: 243-251
        • Rakovitch E.
        • Franssen E.
        • Kim J.
        • et al.
        A comparison of risk perception and psychological morbidity in women with ductal carcinoma in situ and early invasive breast cancer.
        Breast Cancer Res Treat. 2003; 77: 285-293
        • van Gestel Y.R.
        • Voogd A.C.
        • Vingerhoets A.J.
        • et al.
        A comparison of quality of life, disease impact and risk perception in women with invasive breast cancer and ductal carcinoma in situ.
        Eur J Cancer. 2007; 43: 549-556
        • Aspegren K.
        • Holmberg L.
        • Adami H.O.
        Standardization of the surgical technique in breast-conserving treatment of mammary cancer.
        Br J Surg. 1988; 75: 807-810
        • Lagergren J.
        • Jurell G.
        • Sandelin K.
        • Rylander R.
        • Wickman M.
        Technical aspects of immediate breast reconstruction with implants: five year follow-up.
        Scand J Plast Reconstr Surg Hand Surg. 2005; 39: 147-152
      1. Sullivan M. Karlsson J. Ware Jr., J. Swedish manual and interpretation guide. International quality of life assessment (IQLA) Project. Health care Research Unit. Medical faculty. Gothenburg University and Sahlgrenska Hospital, Gothenburg1994
        • Sullivan M.
        • Karlsson J.
        • Ware Jr., J.E.
        The Swedish SF-36 health survey–I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden.
        Soc Sci Med. 1995; 41: 1349-1358
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatr Scand. 1983; 67: 361-370
        • Bjelland I.
        • Dahl A.A.
        • Haug T.T.
        • Neckelmann D.
        The validity of the hospital anxiety and depression scale. An updated literature review.
        J Psychosom Res. 2002; 52: 69-77
        • Arving C.
        • Glimelius B.
        • Brandberg Y.
        Four weeks of daily assessments of anxiety, depression and activity compared to a point assessment with the hospital anxiety and depression scale.
        Qual Life Res. 2008; 17: 95-104
        • Hopwood P.
        • Fletcher I.
        • Lee A.
        • Al Ghazal S.
        A body image scale for use with cancer patients.
        Eur J Cancer. 2001; 37: 189-197
        • Nekhlyudov L.
        • Kroenke C.H.
        • Jung I.
        • Holmes M.D.
        • Colditz G.A.
        Prospective changes in quality of life after ductal carcinoma-in-situ: results from the Nurses’ Health Study.
        J Clin Oncol. 2006; 24: 2822-2827
        • Amichetti M.
        • Caffo O.
        • Arcicasa M.
        • et al.
        Quality of life in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation.
        Breast Cancer Res Treat. 1999; 54: 109-115
        • Sprangers M.A.
        • Schwartz C.E.
        Integrating response shift into health-related quality of life research: a theoretical model.
        Soc Sci Med. 1999; 48: 1507-1515
        • Hartl K.
        • Janni W.
        • Kastner R.
        • et al.
        Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients.
        Ann Oncol. 2003; 14: 1064-1071
        • Arndt V.
        • Stegmaier C.
        • Ziegler H.
        • Brenner H.
        Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study.
        J Cancer Res Clin Oncol. 2008; 134: 1311-1318
        • Rowland J.H.
        • Desmond K.A.
        • Meyerowitz B.E.
        • Belin T.R.
        • Wyatt G.E.
        • Ganz P.A.
        Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors.
        J Natl Cancer Inst. 2000; 92: 1422-1429
        • Parker P.A.
        • Youssef A.
        • Walker S.
        • et al.
        Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer.
        Ann Surg Oncol. 2007; 14: 3078-3089
        • Al-Ghazal S.K.
        • Fallowfield L.
        • Blamey R.W.
        Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction.
        Eur J Cancer. 2000; 36: 1938-1943
        • Schover L.R.
        • Yetman R.J.
        • Tuason L.J.
        • et al.
        Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality.
        Cancer. 1995; 75: 54-64