Breast cancer: epidemiology, prevention, and treatment

Breast Cancer

Project Title: Women who chose Lumpectomy Over Prophylactic Mastectomy as Treatment for Early Stage Breast Cancer May have an Increased Risk for Post-Treatment Anxiety Regarding Fear of Recurrence.

This proposed research plan will address the post treatment psychology of Stage I breast cancer patients who have received the less invasive breast retention surgery, referred to as lumpectomy.

Do women with early stage breast cancer have more intrusive thoughts (stress) regarding recurrence after lumpectomy than after prophylactic mastectomy? Within the survivor group the study will specifically address issues of psychological anxiety related to recurrence of cancer. The study will be retrospective, based upon cognitive memories of post treatment anxiety related to recurrence of breast cancer and subjects will be chosen in a non-random fashion. The main research query will be: Do women who choose prophylactic mastectomy after early stage breast cancer return to their pre-diagnostic sense of wellness as compared to women who choose lumpectomy? The basic decision associated with breast cancer treatment has often centered around post treatment body image associated with radical mastectomy, leaning treatment decision in the way of breast retention surgery, and away from the more traditional prophylactic mastectomy. (Rowland, Desmond, Meyerowitz, Belin, Wyat, Ganz. 2000, pg. 1422) (Parson, 2001, pg. 154) (Kissane, Clarke, Ikin, Bloch, Smith, Vitetta, McKenzie, 1998, pgs. 192-197) (Norton, 2003, 29-30) Recovery from breast cancer should always take into consideration the long-term psychological effects of all treatment plans.

Review of the Literature:

The literature associated with post treatment anxiety in breast cancer treatment, though rather limited gives at least some indication that there is a greater risk for anxiety related to recurrence of breast cancer among women who choose lumpectomy over mastectomy. (McCarthy, 1987, pg. 17) In one study it was determined that the anxiety of having breast cancer far outweighed the anxiety of treatment or options, leaving some to regard the possible increased chance fro recurrence after lumpectomy to outweigh the benefits of breast retention options. (Wisconsin, 1989, pgs. 10-11) Though there is much evidence that the two treatments, mastectomy and lumpectomy with radiation follow-up are statistically similar for long-term life expectancy rates,(Zepf, 2003, pg. 1362) (Fisher, Anderson, Bryant, Margolese, Deutsch, Fisher, Jeong, Wolmark, 2002, pgs. 1233-1242) (Mechcatie, 2002, pg. 6) (Harrar, 2003, pg. 140) excluding some statistics that indicate women who are younger when they have lumpectomies have a greater risk for reoccurrence (Ford, 2003, pg. 50-51) challenges associated with the psychological effects of treatment outcomes have been raised repeatedly but much more research is needed. (Schain, d'Angelo, Dunn, Lichter, Pierce, 1994 pages 1221-1229) One study concludes that there is simply no evidence that the benefits of breast retention outweighs the possible psychological effects of fear of reoccurrence (Fallowfield, Hall, Maguire, Baum 1990, pgs. 575-583) "Recent research from Great Britain, however, suggests that lumpectomy patients are just as likely to experience distress as those who undergo the more radical procedure." (McCarthy, 1987, pg. 17) Additionally there is also evidence that women who undergo the more radical mastectomy recover psychologically just as well as those who undergo lumpectomy "Women who have undergone a mastectomy for breast cancer adapt as well psychologically as those treated with surgery designed to preserve breast tissue, according to a study at the University of Wisconsin Clinical Cancer Center (UWCCC)." (Wisconsin 1989, pgs. 10-12) All of this information collectively leads researchers to indicate a need for further study of the negative psychological effects of lumpectomy.

Problem:

The problem is that many clinicians and patients assume that the psychological effects of breast retention and all of its benefits, as compared to mastectomy outweigh any possible long-term anxiety about recurrence. Yet there is significant evidence that this is not the case and this must be explored further to create a better knowledge base for women, their families and their physicians.

Hypothesis:

Women who chose lumpectomy over prophylactic mastectomy as treatment for early stage breast cancer have an increased risk for post-treatment anxiety in relation to fear of cancer recurrence.

Design:

Research design will sample at least 250 cancer patients one year after treatment, hopefully a statistical half of the study will belong to each group, mastectomy and lumpectomy with radiography.

The sample will be obtained through a women's cancer center, and will be a voluntary study. Patients will be recruited through a letter offering availability of study to post treatment patients. Informed consent will be obtained upon acceptance of interest following first contact response of the letter. Data will consist of a questioner associated with the psychological theme of fear of recurrence. The number of recurrence thoughts will be compared within the two groups. The limitations of this study are related to the retrospective technique as self-report and memory have inherent flaws, yet the assumptions of the study, that there is a significant concern associated with posttraumatic stress after lumpectomy require further assessment.

B. Zepf, B. (March 15, 2003) " Lumpectomy vs. mastectomy in breast cancer treatment."

American Family Physician, pg.1362.

B. Fisher, S. Anderson, J. Bryant, R.G. Margolese, M. Deutsch; E.R. Fisher; Jong-Hyeon

J., N. Wolmark. (Oct 17, 2002) 'Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer." The New England Journal of Medicine, 347/16 p1233-1242.

M. Parson, (Oct. 2001) "A choice you can Live with" MPLS-St. Paul Magazine, 2/10 pg.

J.H. Rowland; K.A. Desmond; B.E. Meyerowitz; T.R. Belin; G.E. Wyatt; P.A.