Fear of recurrence, breast‐conserving surgery, and the trade‐off hypothesis

Fear of recurrence has been at the heart of the controversy between surgeons favoring mastectomy versus those advocating a less radical operation. Breast‐conserving surgery is thought to result in a better body image, but patients are expected to worry more about a cancer recurrence because only a s...

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Bibliographic Details
Published in:Cancer 1992-04, Vol.69 (8), p.2111-2115
Main Authors: Lasry, Jean‐Claude M., Margolese, Richard G.
Format: Article
Language:English
Subjects:
Breast Neoplasms - psychology
Breast Neoplasms - radiotherapy
Breast Neoplasms - surgery
Fear
Humans
Mastectomy, Segmental - psychology
Mastectomy, Simple - psychology
Neoplasm Recurrence, Local - psychology
Neoplasm Recurrence, Local - surgery
Prospective Studies
Survival Analysis
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Summary:Fear of recurrence has been at the heart of the controversy between surgeons favoring mastectomy versus those advocating a less radical operation. Breast‐conserving surgery is thought to result in a better body image, but patients are expected to worry more about a cancer recurrence because only a small part of the breast is excised. To assess survival rates after breast‐conserving intervention, patients were randomized into the National Surgical Adjuvant Breast Project (NSABP) prospective clinical trial (Protocol B06) with three treatment groups: total mastectomy, lumpectomy, and lumpectomy followed by radiation therapy. A fourth group was created to include patients who had a recurrence after their first operation and thus underwent a subsequent total mastectomy. Differences appeared, not according to the type of treatment, but with respect to the number of surgical interventions. Patients with multiple operations reported a greater fear of cancer recurrence and a worse body image, similar to those that underwent total mastectomy, Contrary to the trade‐off hypothesis, patients who underwent radical surgery did not manifest less fear of recurrence. These results show unequivocally that the expected trade‐off between breast conservation and fear of cancer recurrence does not occur. Those who undergo lumpectomy do not more express more fear of cancer than do patients who undergo mastectomy.
ISSN:0008-543X
1097-0142
DOI:10.1002/1097-0142(19920415)69:8<2111::AID-CNCR2820690817>3.0.CO;2-T