A Pilot Assessment of Ethnic Differences in Cosmetic Outcomes following Breast Conservation Therapy.

Preservation of the aesthetic appearance of the breast is one of the primary goals of breast conserving therapy (BCT) for breast cancer. This approach spares a significant percentage of the native breast tissue, which increases the potential for improved cosmetic outcomes. However, there are reports in the literature that the aesthetic benefits of BCT may not be shared equally among ethnic groups as both clinical experience and limited evidence in the literature suggest that African American women may experience worse postoperative cosmesis than white women.1–3 For example, previous studies have identified 19–28% of African American patients as having fair/poor outcomes (72–81% with excellent/good outcomes) compared with 5–18% of white patients who have fair/poor outcomes (82–95% with excellent/good outcomes).1–3 However, these studies are hampered by 2 main issues: first, there is no consensus as to what constitutes an optimal aesthetic result following BCT, and second, no validated assessment instrument of aesthetic outcomes exists to help form such a consensus.4,5 Although it is likely that there are many factors that affect aesthetic outcomes following BCT such as scarring and reaction to radiation, these variables are not captured in existing assessments.1–3,6 This lack of specificity is significant given that preserving breast aesthetics is one of the primary goals of BCT. If the factors that influence aesthetic outcomes following BCT can be established, it may be possible to tailor treatment regimens to optimize aesthetics while preserving oncologic efficacy. Therefore, both to evaluate cosmetic differences between African American and white patients following BCT and to take an initial step toward the development of a consensus-driven evaluation to define optimal cosmetic outcome in BCT, we propose a multimodal approach to assessment that includes patient- and clinician-reported outcome measures and objective measurements. To this end, this study reports on the outcome data from a pilot study of African American and white women who underwent BCT at the Lynn Sage Comprehensive Breast Center at Northwestern Memorial Hospital.