Nationwide study finds breast cancer patients unaware of surgical options

The majority of women who underwent lumpectomy or mastectomy surgeries for breast cancer report that the scars from those surgeries negatively affect their daily lives. Yet one-third of patients said that their physician did not tell them about surgical options that minimize scarring, according to a report published recently by the journal BMC Cancer.

Breast cancer is the second most common type of cancer worldwide, with an estimated 269,000 newly diagnosed cases and more than 42,000 deaths in the U.S. in 2019, according to the National Institutes of Health. More than 3.5 million women in the U.S. have survived breast cancer, many of whom bear scars from surgical treatments.

“After surviving the trauma of cancer, many women must still battle with the psychological and physical consequences of both a new cancer diagnosis and its treatment,” said author Jennifer S. Gass, MD, FACS, chief of surgery at Women & Infants Hospital, a Care New England hospital; director of the breast fellowship at the Breast Health Center at Women & Infants; a member of the Care New England Medical Group; and clinical assistant professor at The Warren Alpert Medical School of Brown University.

“Our findings illustrate how important it is for surgeons to ensure their patients are aware of the long-term impact of cancer surgery and how it will affect their bodies. Patients should know if they might be candidates for surgical options that minimize morbidity. A surgical scar is a morbidity,” said Dr. Gass.

The survey reports that two-thirds of respondents do not like the location of their scar. This scar impacted the daily lives of many women, in terms of feeling self-conscious and affecting clothing choices. Yet, one in three breast cancer patients said their physician never told them about surgical options to reduce the visibility of their scars and thus potentially the psychological and physical impact of scars.

The survey of 487 women who had undergone lumpectomy and/or mastectomy surgeries is the first peer-reviewed, nationwide study to examine the negative association of surgical scars and breast cancer survivorship, how those scars affect their lives, and whether scars matter. The survey found:

• 64 percent of women treated with lumpectomy-only and 67 percent of women treated with mastectomy-only reported they did not like the location of their surgical scar.
• 63 percent of lumpectomy respondents and 77 percent of mastectomy-only respondents feel self-conscious about their scars.
• 57 percent of lumpectomy-only and 66 percent of mastectomy-only patients decide not to wear certain pieces of clothing because it reveals their breast cancer surgery scars.
• 32 percent of lumpectomy-only respondents and 35 percent of mastectomy-only respondents stated their physician did not inform them about surgical options such as nipple-sparing mastectomy or hidden scar techniques. Of those respondents, about six in 10 stated they would have considered those options if their doctor had told them about it.
• 60 percent of respondents who had lumpectomy-only and 72 percent of respondents who had mastectomy-only said they did not realize before their surgery how uncomfortable their scars would make them feel when they are undressed.
• Only 26 percent of lumpectomy-only respondents and 14 percent of mastectomy-only respondents reported minimal or no negative impact as a consequence of surgical scars.

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The study was co-authored with Sunny Mitchell, MD, and Michael Hanna, PhD.