Objectives-To assess outside a clinical trial the psychological outcome of different treatment policies in women with early breast cancer who underwent either mastectomy or breast conservation surgery depending on the surgeon's opinion or the patient's choice. To

Summary and conclusionsThe psychiatric morbidity associated with mastectomy was assessed in 75 women by following them up from the time they presented with suspected breast cancer to one year after the operation. Fifty women with benign breast disease served as controls. Throughout the follow-up period the incidence of psychiatric problems was higher among the women who had undergone mastectomy. One year after surgery 19 (25%) of these women compared with only 5 (10%) of the controls needed treatment for anxiety or depression or both, and 16 (33%) compared with 3 (8%) respectively had moderate or severe sexual difficulties. Altogether 29 patients in the mastectomy group (39%) and six of the controls (12%) had serious anxiety, depression, or sexual difficulties. Of the eight women in the mastectomy group who sought help for their problems, only two felt that the help given had been appropriate.The inability to recognise and treat these emotional

Psychiatric morbidity was assessed in 101 women treated for early breast cancer (To, 1, 2, No, 1, Mo). Patients had expressed no strong preference for treatment, so were randomised to either mastectomy or breast conservation. The incidence of anxiety states or depressive illness, or both, among women who underwent mastectomy was high (33%) and comparable with that found in other studies. Slightly more of the patients who underwent a lumpectomy followed by radiotherapy had affective disorders, 38% having an anxiety state, depressive illness, or both.These findings question the view that mutilating treatment is predominantly responsible for the measurable psychiatric morbidity reported previously. Counselling services should be provided for all women treated for breast cancer, not just those who undergo mastectomy.

Psychiatric morbidity was assessed in 101 women treated for early breast cancer (To, 1, 2, No, 1, Mo). Patients had expressed no strong preference for treatment, so were randomised to either mastectomy or breast conservation. The incidence of anxiety states or depressive illness, or both, among women who underwent mastectomy was high (33%) and comparable with that found in other studies. Slightly more of the patients who underwent a lumpectomy followed by radiotherapy had affective disorders, 38% having an anxiety state, depressive illness, or both.These findings question the view that mutilating treatment is predominantly responsible for the measurable psychiatric morbidity reported previously. Counselling services should be provided for all women treated for breast cancer, not just those who undergo mastectomy. IntroductionThere is growing evidence that in early breast cancer relapse free intervals and survival rates are comparable in patients treated either by mastectomy or by local excision and radiotherapy.' These data, together with reports that women who undergo mastectomy suffer