Does cosmetic outcome from treatment of primary breast cancer influence psychosocial morbidity?

Aims: To investigate any influence of cosmetic outcome on psychosocial morbidity in patients who have undergone breast-conserving surgery for primary breast cancer. Methods: Cosmetic outcome was assessed both objectively and subjectively in 254 patients, aged 20-69 years, who underwent breast-conserving surgery for operable primary breast cancer, less than or equal to 3 cm in diameter; most women also received post-operative intact breast irradiation. Patients completed questionnaires assessing satisfaction with the outcome and assessing other psychosocial morbidity using the Hospital Anxiety Depression scale, the Body Image questionnaire and the Rosenberg Self-esteem scale. Results: Patient satisfaction was high (90.5% of the patients were very or moderately satisfied). There was an excellent correlation between cosmesis and levels of anxiety (r= -0.81, P<0.001) and depression (r= -0.7, P<0.001) and between cosmesis and body image (r= -0.4, P<0.001), sexuality (chi(2)=22, P=0.001) and self-esteem (r=-0.64, P<0.001). Conclusions: This study has shown that the cosmetic result achieved has a marked bearing on the subsequent development of psychological outcome.