Risk Factors of Cosmetic Outcome in Early Breast Cancer Patients After Breast Conserving Therapy

Abstract

Aim: In early breast cancer treated with breast conserving therapy (BCT) the cosmetic effect is an important element of the final outcome. The aim of the study was to evaluate the cosmetic effect of 187 out of 203 consecutive patients with stage 0, I and II breast cancer treated conservatively and to identify the negative factors influencing cosmesis. Material and Methods: From the entire group of 203 consecutive breast cancer patients with stage 0, I, and II treated with BCT at one oncological institution between 1994-1999, 187 women underwent cosmetic evaluation. The time of observation was 48-103 months, (median 74 months). Cosmesis was assessed qualitatively (subjectively) by the medical panel and patients themselves and quantitatively (objectively) by the medical panel, using measurements and comparing the treated breast with untreated. The relationship between cosmesis and the factors related to the disease and its management (breast size, localization of the tumour, clinical vs preclinical status, type of surgery, radiotherapy to the lymph nodes, breast boost type, adjuvant chemotherapy) was analyzed. Statistical analysis was performed using a logistic regression model. Marginal homogeneity test and Cohen kappa was calculated in order to assess the uniformity of opinion between doctors and patients. Results: According to the medical panel the cosmetic results were assessed as excellent in 59.5% of cases, as good in 34%, as fair in 6.5% of cases with no bad cosmetic results. In the opinion of the patients 67% of cases were assessed as excellent, 23.5% as good, 7.5% as fair and 2% as bad. Statistical analysis based on marginal homogeneity test and Cohen- Kappa did not confirm any concordance between the opinions of both patients and therapists. The two factors found to limit the chance of achieving the excellent cosmetic effect were: quadrantectomy (p = 0.007) and brachytherapy boost (p = 0.004). All the other factors analyzed: the size of the breast, the localization of the tumor, a non-palpable lesion and adjuvant treatment- did not influence the cosmetic outcome (p>0.1). Conclusions: BCT performed according to the guidelines applied at the Cancer Centre in Warsaw Poland provides satisfactory (excellent or good) cosmetic effect in large majority of patients (93%). A discrepancy between the cosmetic effects as evaluated qualitatively by the patients and by the medical panel was observed. The two factors limiting the chance of achieving an excellent cosmetic effect were quadrantectomy and HDR Ir192 brachytherapy boost.