Quality of life considerations
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From the first suspicions of cancer, formed when a woman or her doctor observes signs or symptoms that imply disease, just the possibility of having breast cancer can have a significant impact on the patient’s quality of life. In the affected families, breast cancer causes immeasurable anxiety, suffering and loss.
Some women fear the disease and its consequences so much that they ignore the symptoms, hoping that they will resolve spontaneously, and this delay can lead to a poor prognosis.
Inevitably, the degree to which the disease will impact on quality of life depends on its characteristics (stage, aggressiveness, etc) and the course of treatment chosen by the patient and physician.
Even for women with early stage disease who have a good prognosis, there is a significant incidence of disease recurrence, and patients often spend the remainder of their life under the shadow of the possibility of the disease returning in the future.
Body image issues
In our culture, the breasts represent a basic aspect of beauty and femininity; diagnosis of breast cancer can severely impact on a woman’s feelings of well-being, wholeness, sexuality and attractiveness.
A woman’s choice of treatment is often influenced by her age, the image she has of herself and her body, her hopes and fears, and her place in life.
For example, some women may select breast-conserving surgery with radiation therapy over a mastectomy for cosmetic and body image reasons.
Other women, with a similar diagnosis, may choose mastectomy, wanting the affected area removed, irrespective of the effect on their body image.
Issues of sexuality are often of some concern to women with breast cancer.
Several factors may place a woman at higher risk for sexual problems after breast cancer.
Treatments, such as chemotherapy, can change a woman’s hormone levels and may negatively impact on sexual interest and/or response.
A diagnosis of breast cancer when a woman is in her 20s or 30s is especially difficult because choosing a partner and childbearing are often very important life decisions during this period.
Surgery
Losing a breast, or occasionally both breasts is, for any woman a traumatic experience and careful evaluation of the patient education and support, both before and after surgery, is necessary to reduce the levels of distress and life-dissatisfaction.
Although the number of women with breast cancer having breast conservation therapy is increasing, there are some women who, for medical or personal reasons, opt for mastectomy.
Breast reconstruction, which may be performed at the same time as the mastectomy or at a later date, restores the shape of the breast, but does not restore normal breast sensation; breast reconstruction generally makes women more comfortable with their bodies, however, and helps them feel more attractive
Reconstruction often involves the use of silicone implants; however, techniques using tissue from other parts of the body (free flap procedures) are also an option.
Recent studies suggest that a procedure involving skin-sparing mastectomy is as effective as modified radical mastectomy for many women, and offers the advantage of less scar tissue and a reconstructed breast that appears more natural.
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