Mastectomy Versus Conservative Surgery

Abstract

Women with early breast cancer were offered the choice of a mastectom lurnpectomy plus radiotherapy, or entry in a trial in which the alrdcation to either type of treatment was randomized. Few women chose the trial, and most were relieved that a choice was available. Othel patients, for whom it was decided that a mastectomy was the only viable treatment on medical grounds, were offered breast reconstruction whenever it was technically feasible. Psychosocial adaptation was measured using tests of anxiety, depression, marital adjustment, body satisfaction, self-esteem, sociability, and life change. Tests were given before surgery at intervals up to one year afterward. The degree of concern the women felt about the disease, their appearance, and the treatment was also assessed. The major difference among the groups was in the degree of concern about appearance. Women who rated high in this regard (the younger patients) tended to choose conservative surgery or reconstruction when a mastectomy was necessary. Generally, the adjustment to treatment was good in all the groups, despite some anxiety when the patients were in the hospital for surgery. Tailoring the treatment to each woman's preference resulted in low psychological morbidity.