Breast conservation versus mastectomy: Distress sequelae as a function of choice

S. M. Levy, R. B. Herberman, J. K. Lee, M. E. Lippman, T. d'Angelo

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98 Scopus citations


Between 1981 and 1984, 93 stage I and II breast cancer patients were entered onto a trial at the National Cancer Institute (NCI) randomizing patients to excisional biopsy plus radiation v mastectomy. Between 1984 and 1987, 98 stage I and II breast cancer patients were entered onto a behavioral study in Pittsburgh, approximately 70% of whom elected to have breast conservation surgery. Patients at both sites were assessed three to five days postsurgery, and again at 3-month's follow-up, using a well-validated mood measure, the Profile of Mood States (POMS). There were no demographic or disease differences between the two samples. In the Pittsburgh sample, using a repeated measures multivariate analysis of covariance (MANCOVA) analysis, after adjusting for menopausal status and radiotherapy and chemotherapy toxicity, the conservation group was psychologically worse off (F = 2.7, P < .03). For example, they were significantly more distressed over time (F = 5.5, P < .02), and more depressed in general (F = 9.2, P < .005). Using Karnofsky ratings, the two groups were identical in terms of disability at 3-month's follow-up. In contrast, for the NCI patients participating in the randomized trial, after adjusting for chemotherapy and radiotherapy treatments, reported overall distress decreased over time (F = 17.4, P < .0001) for all patients, irrespective of treatment group, and the between-groups MANCOVA was not significant. Thus, when comparing the two samples, when 'choice' played a major role, the conservation patients were psychologically worse off - at least at 3-month's follow-up. If there was a biological advantage, it would have favored the conservation group. However, the psychological prospective data showed just the opposite pattern. The assumption that a woman is psychologically better off opting for breast conservation may need to be re-examined.

Original languageEnglish (US)
Pages (from-to)367-375
Number of pages9
JournalJournal of Clinical Oncology
Issue number3
StatePublished - 1989

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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