Breast-Conserving Therapy vs Mastectomy for Early-Stage Breast Cancer: Should We Re-Evaluate the Current Treatment Paradigm?: Reply to Jatoi

Evaluation of quality of life and socio-emotional impact of oncological treatment among patients with breast cancer

Breast cancer is the most frequent cancer in women worldwide. Quality of life (QoL) is significantly affected by both surgical and oncological treatment. The aim of this study was to assess and compare QoL, resilience and depression scores among women who had breast cancer treatment. We assessed 170 patients diagnosed with breast cancer in a non-experimental, descriptive study through anonymized questionnaires from January to March 2024. Patients were invited to fill in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Breast Cancer Module (EORTC QLQ-BR23) questionnaire, the Depression Anxiety Stress Scale, the CD-RISC 10 questionnaire, and the MOS Social Support Survey. Clinical information and demographical data were obtained and statistical analysis was conducted to evaluate factors that affect QoL, resilience and depression scores. QoL was significantly influenced by chemotherapy and surgery. Women with higher resilience scores had lower anxiety and depression scores and reported a better QoL. Women with strong social support and high resilience reported a better QoL during and after breast cancer treatment. The results of our study show that breast cancer surgery and chemotherapy have an important impact on patients' QoL. Moreover, the results reflect the importance of both medical treatment and social support as resilience-building strategies in managing and improving the QoL of patients.

Outcomes of Breast-Conserving Surgery Plus Radiation vs Mastectomy for All Subtypes of Early-Stage Breast Cancer: Analysis of More Than 200,000 Women

BACKGROUND

Recent large retrospective studies suggest that breast-conserving therapy (BCT) plus radiation yielded better outcomes than mastectomy (MST) for women with early-stage breast cancer (ESBC). Whether this is applicable to the different subtypes is unknown. We hypothesize that BCT yielded better outcomes than MST, regardless of subtypes of ESBC.

STUDY DESIGN

Data on women diagnosed with first primary stage I to II breast cancer between 2010 and 2017 who underwent either BCT or MST were from the population-based 18 Surveillance, Epidemiology, and End Results cancer registries. The Kaplan-Meier method was used to estimate unadjusted 5-year overall survival and cause-specific survival. Univariable and multivariable Cox proportional regression models were used to determine the impact of surgical approaches on the hazard ratios adjusted for relevant demographic and clinical variables for molecular subtype (luminal A, luminal B, triple-negative, and HER2 enriched).

RESULTS

Of the 214,128 patients with breast cancer, 41.6% received MST. For the different subtypes, BCT yielded better 5-year overall survival and cause-specific survival than MST. After adjusting for demographic and clinical factors, the risk of overall survival and cause-specific survival was still statistically significantly higher among MST recipients than BCT recipients for all subtypes.

CONCLUSIONS

BCT yielded better survival rates than mastectomy for women with all subtypes of ESBC. The role of mastectomy for women with ESBC should be reassessed in future clinical trials.