FEAR OF RECURRENCE, BREAST-CONSERVING SURGERY, AND THE TRADE-OFF HYPOTHESIS

Citation
Jcm. Lasry et Rg. Margolese, FEAR OF RECURRENCE, BREAST-CONSERVING SURGERY, AND THE TRADE-OFF HYPOTHESIS, Cancer, 69(8), 1992, pp. 2111-2115
Citations number
23
Language
INGLESE
art.tipo
Article
Journal title
CancerACNP
ISSN journal
0008-543X
Volume
69
Issue
8
Year of publication
1992
Pages
2111 - 2115
Database
ISI
SICI code
0008-543X(1992)69:8<2111:FORBSA>2.0.ZU;2-T
Abstract
Fear of recurrence has been at the heart of the controversy between su rgeons favoring mastectomy versus those advocating a less radical oper ation. Breast-conserving surgery is thought to result in a better body image, but patients are expected to worry more about a cancer recurre nce because only a small part of the breast is excised. To assess surv ival rates after breast-conserving intervention, patients were randomi zed into the National Surgical Adjuvant Breast Project (NSABP) prospec tive 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 af ter their first operation and thus underwent a subsequent total mastec tomy. Differences appeared, not according to the type of treatment, bu t 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. C ontrary to the trade-off hypothesis, patients who underwent radical su rgery did not manifest less fear of recurrence. These results show une quivocally that the expected trade-off between breast conservation and fear of cancer recurrence does not occur. Those who undergo lumpectom y do not more express more fear of cancer than do patients who undergo mastectomy.