From the July 2022 issue of HealthCare Business News magazine
Other patient-related factors include fear of disfigurement or decrease in breast size after a lumpectomy, as well as anxiety regarding radiation therapy and the ability to comply with the required time commitment (typically 10 minutes per day, 5 days per week for 4-6 weeks). In addition, some patients consider body image to be an important aspect of survivorship, and breast symmetry may be a priority. While this can certainly be achieved with mastectomies and breast reconstruction using implants or a patient’s own tissues, the options of breast reductions and lifts in patients choosing a lumpectomy should also be discussed. These concerns and goals of treatment are important to ascertain, as a decrease in compliance with recommended therapy and dissatisfaction with breast appearance are both associated with worse patient outcomes.
Interestingly, a paper published in the Annals of Surgical Oncology reported that the preference for mastectomy may be partially attributed to a media focus on celebrities with breast cancer and inherited genetic mutations. This shift known as the “Angelina Jolie Effect” was popularized after the actress publicly announced her decision to remove both breasts. However, Ms. Jolie was diagnosed with a pathogenic mutation in the BRCA 1 gene, predisposing her to a significantly increased risk for developing breast cancer. Mastectomies are strongly considered and even recommended in this situation; however, this benefit does not apply to patients who are at average-risk for developing breast cancer. Clinicians must be aware of the strong influential relationship that exists between social media on patient assumptions and subsequent expectations.
It is well documented that younger women are more likely to present with highly proliferative molecular subtypes (i.e., HR negative, triple negative, HER2 positive breast cancer), which are typically associated with clinically aggressive disease and disparaging long-term outcomes. Not surprisingly, our study found that compliance with hormonal therapy in patients with HR positive disease was associated with improved survival. In addition, we also found that black race was associated with an almost six times increased risk of death in the triple negative sub-group. This is consistent with previous studies showing an increase in breast cancer burden in black women when compared to white women, representing one of the most notable examples of disparities in oncology that is related to racial identity. This finding emphasizes the need to focus attention on racial outcome disparities in young women, with future studies improving upon the representation of minorities in breast cancer research.