Older women who undergo surgery for breast cancer often worry about their appearance afterward, and getting the treatment that best meets these concerns may improve their long-term well-being, according to a new study.

Body image after breast cancer is often regarded as a concern of younger women, with some past studies suggesting that older women are not as worried about what they will look like after having a breast or breast tissue removed.

However, the new study, of 563 breast cancer patients age 67 and up, found that many considered their physical appearance important. And nearly one-third said body image was a factor in their decision about whether to undergo a complete mastectomy or have breast-conserving surgery, in which only the tumor and surrounding tissue is removed.

Moreover, among all women who considered their physical appearance important, those who received breast-conserving surgery showed better mental health two years later compared with those who had a breast removed.

Women who were concerned about their appearance but underwent mastectomy had the poorest scores on standard tests of mental well-being, according to findings published in the Journal of Clinical Oncology.

The findings suggest that matching treatment to older patients’ preferences about appearance, when possible, may improve their long-term quality of life, report Dr. Melissa I. Figueiredo, of Georgetown University in Washington, D.C., and colleagues.

Doctors, they note, should broach the topic with older women, who may rely on them to initiate such discussions.

The study involved older women who were treated for earlier-stage breast cancer at one of 29 U.S. hospitals. The women ware interviewed three months after surgery about their body image before and after the procedure, and whether appearance had been a factor in their treatment decision. They also completed a standard questionnaire on mental well-being.

Follow-up interviews were conducted one and two years after surgery.

As expected, the researchers report, women who had mastectomies had more body image concerns after surgery than those who had a breast-conserving procedure - and the women with the greatest concerns were those who considered physical appearance important but received a mastectomy. This group also scored the lowest on mental health measurements.

The researchers conclude that “prior assumptions” that body image does not matter to older women may be wrong, and that it’s important to ask these patients about the value they place on appearance when discussing treatment options.

SOURCE: Journal of Clinical Oncology, October 1, 2004.