Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q

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We have read with great interest the article entitled, “Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q”1 by Mundy et al., as well as the two related articles, “Normative Data for Interpreting the BREAST-Q: Augmentation”2 and “Understanding the Health Burden of Macromastia: Normative Data for the BREAST-Q Reduction Module.”3 We commend the authors for endeavoring to establish normative values for the BREAST-Q and similarly value evaluating breast satisfaction among women without a history of breast cancer or surgery. As the authors discussed, numerous breast surgical outcomes studies have used the BREAST-Q since its introduction1; its application in a general population serves as a valuable comparison for existing and future research, adding context to breast surgical patient scores and potentially serving as a standard or benchmark for these patients.
The large sample size the authors captured in each study is remarkable, particularly given the homogeneity of the subjects’ demographic characteristics across the three studies. We found it informative to compare scores between studies for each scale (Table 1). While three of four common scales had comparable scores (e.g., Satisfaction with Breasts, interstudy means range, 54 to 58), one scale varied greatly among the three studies: Physical Well-being Chest. Mean scores for this scale ranged from 76 (Reduction module) to 86 (Augmentation module) to 93 (Reconstruction module). We are hoping that the authors may comment on this 17-point difference between the Reduction and Reconstruction modules, particularly since it exceeds the mean minimal important difference reported to be 7 to 10.4 Notably, this difference may indicate mastectomy and breast-conserving therapy patients who have historically been evaluated using the Reconstruction module1 and now would be evaluated using the Mastectomy and Breast Conserving Therapy modules may not have comparable data for the Physical Well-being Chest domain.
In addition, we appreciate the authors’ discussion of the demographics of their normative values cohort. In this study, 92 percent of women were white non-Hispanic, 84 percent had a college degree or above (with 39 percent holding a master’s or doctoral degree), and 44 percent cited an annual gross household income greater than $100,000. Although we view this population as an improvement over the previous sample reported,5 we feel strongly that a more diverse normative population would further elucidate differences between normative values and those of breast surgery patients, particularly because certain socioeconomic factors such as education, income, and employment status have been correlated with differences in BREAST-Q scores. This differs somewhat from the authors’ findings that age, income, body mass index, and bra cup size influence differences in scores in the Army of Women population. Nevertheless, we appreciate this excellent work and how it is advancing the study of quality of life and satisfaction in breast surgery patients. We look forward to the authors’ response.

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