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Breast conservation versus mastectomy: psychological considerations
1Cancer Research Campaign Psychological Medicine Group, Christie Hospital, Manchester, England.
Seminars in Surgical Oncology
|January 1, 1989
Summary
Mastectomy significantly impacts psychological health. While counseling shows no preventive effect, monitoring and surgical reconstruction can mitigate psychological distress in breast cancer patients.
Area of Science:
- Oncology
- Psychiatry
- Psychology
Background:
- Mastectomy is linked to significant psychological and psychiatric distress.
- Existing evidence does not support counseling as a preventative measure for this distress.
Purpose of the Study:
- To review the psychological impact of breast cancer treatments.
- To identify factors influencing psychological morbidity and suggest management strategies.
Main Methods:
- Review of available evidence on psychological outcomes following mastectomy and breast conservation.
- Analysis of the impact of surgical techniques, adjuvant therapies, and patient choice on mental health.
Main Results:
- Immediate or delayed reconstruction can reduce psychiatric morbidity related to body image concerns.
- Adjuvant chemotherapy and persistent arm pain/swelling increase psychiatric morbidity.
- Breast conservation may reduce body image issues but increase anxiety about recurrence and depression from radiotherapy.
- Allowing patient choice in surgical approach appears to reduce morbidity.
Conclusions:
- Early detection and treatment of psychological problems are crucial for breast cancer patients.
- Optimizing treatment strategies, such as shorter chemotherapy courses and reduced axillary surgery, may decrease psychiatric morbidity.
- Further research is needed to clarify the role of radiotherapy in psychiatric outcomes.