Impact of sentinel node biopsy on long-term quality of life in breast cancer patients

Breast cancer (BC) is the most common malignancy in women worldwide. At present, the incidence of BC in Europe is 94.3 per 100 000 with a mortality of 26 per 100 000 (Ferlay et al, 2007). Owing to BC screening and new adjuvant systemic and/or hormone therapies, survival after BC has improved by 7–11% over the past few years (Vervoort et al, 2004). Five-year survival in France is about 80% (Sant et al, 2009). As overall survival is good for patients with BC, it is important to assess the impact of BC management (that is, treatment advances) on health-related quality of life (QoL) in patients with BC. Indeed, QoL issues are of interest in BC, because effective methods for detection and treatment have led to an increase in the number of long-term survivors. Surgical procedures for BC have improved according to the results of randomised trials testing new procedures (Lacour et al, 1983; Maddox et al, 1983; Jacobson et al, 1995; Fisher et al, 2002; McCready et al, 2005). Breast-conserving treatment is now regarded as a standard treatment for early BC and sentinel lymph node biopsy (SLNB) became an alternative to axillary lymph node dissection (ALND) in the 1990s (McCready et al, 2005). Sentinel lymph node biopsy is a proven safe surgical method and causes less morbidity than ALND (Krag et al, 1993; Burak et al, 2002) with a smaller impact on QoL (Veronesi et al, 2003; Purushotham et al, 2005; Mansel et al, 2006; Del Bianco et al, 2008; Dabakuyo et al, 2009; Gill, 2009; Wang et al, 2011). Moreover, ALND may result in significant arm morbidity (Kuehn et al, 2000), including wound infections, seroma formation, damage to sensory and motor nerves, pain, loss of strength, impaired range of shoulder motion (Kissin et al, 1986), and lymphedema, which is of particular concern for women undergoing axillary surgery. Lymphedema is the most common long-term morbidity following axillary surgery and it may be associated with decreased limb mobility and functional problems, pain, sleep disturbance, anxiety, depression, poor wound healing and increased risk of infection (Erickson et al, 2001). To our knowledge, no prospective study has assessed QoL after axillary surgery for BC with a long follow-up. The aim of this study was to assess long-term QoL over a period of 6 years in women with BC who underwent ALND, SLNB or SLNB followed by ALND.