Breast carcinoma is the most frequently diagnosed malignancy among women and ranks as the second leading cause of cancer-related mortality in females worldwide (1-2).

The diagnostic approach to breast cancer relies on a comprehensive Triple Assessment, which consists of clinical evaluation, radiological imaging, and pathological examination. Mammography is the primary modality for both screening and diagnosis, with any suspicious findings necessitating a biopsy for confirmation.(3) Ultrasound serves as a supplementary imaging technique alongside mammography. Additional imaging tools include Magnetic Resonance Imaging (MRI), which is useful for detecting small lesions that may be overlooked on mammography, though its high cost and lower specificity can lead to overdiagnosis. Positron Emission Tomography (PET) is the most accurate method for assessing tumor spread and evaluating treatment response(4-5).

Breast cancer treatment is primarily based on two major approaches: locoregional treatment and systemic therapy. Treatment strategies are significantly influenced by the tumor's histopathological and molecular characteristics. Optimal management by a specialized multidisciplinary team, adhering to high-quality guidelines, improves survival outcomes and enhances patients' quality of life. Breast cancer management is broadly categorized into three groups: treatment for early breast cancer, locally advanced breast cancer, and metastatic breast cancer.

Early-stage breast cancer is defined as tumors smaller than 5 cm without clinically detectable lymph node involvement. Treatment typically involves surgery, chemotherapy, radiotherapy, and hormonal therapy, depending on the cancer’s stage and molecular subtype. Locally advanced breast cancer (LABC) usually presents with tumors exceeding 5 cm or with clinical lymph node involvement. LABC patients are commonly treated with neoadjuvant therapy, followed by surgery and radiation therapy. In metastatic breast cancer, systemic therapy remains the cornerstone of treatment(1). Historically, radical or modified radical mastectomy was the standard approach for breast cancer management. While mastectomy remains an option in select cases, breast-conserving therapy has emerged as a preferred treatment modality for many patients. Research indicates that in appropriately selected cases of early-stage breast cancer, breast-conserving therapy and mastectomy offer comparable survival outcomes(6).

Beyond the physical burden, breast cancer has substantial emotional and psychological implications. Advances in healthcare and treatment modalities have contributed to improved survival rates and reduced mortality (7). Given these developments, it is essential to consider quality of life as a critical outcome measure in breast cancer patients. Quality of life is a multidimensional construct encompassing physical, psychological, and social well-being. The World Health Organization (WHO) defines quality of life as an individual's perception of their position in life within the context of their cultural and value system, as well as in relation to their goals, expectations, and concerns. It is shaped by various factors, including physical health, psychological state, degree of independence, interpersonal relationships, and interactions with the surrounding environment(8).

Retrospective observational comparative study in patients with breast the study was carried out in the Department of General Surgery at a tertiary –care urban / teaching hospital. On 163 patients

1. c) SELECTION CRITERIA: Breast carcinoma patients at a tertiary- care urban teaching hospital fulfilling the following inclusion and exclusion criteria will be included in the study.

Inclusion Criteria for cases –

• Patient diagnosed with breast carcinoma
• Patients undergoing surgical management for diagnosed operable breast cancer
• Willingness to participate documented through written informed consent.
• Patients above 18 years of age

 Exclusion Criteria –

• Patients with psychiatric illness.
• Patients with Tuberculosis.
• Patients with Retroviral disease.
• Patients with autoimmune diseases.

 The material for the study was collected from patients diagnosed with breast cancer and who had undergone the management for the same Data were collected from medical records, including cancer stage, treatment modalities (surgery, chemotherapy, radiotherapy, hormone therapy), and quality of life (QoL) assessments using the EORTC QLQ-C30 and QLQ-BR23 questionnaires Patients were categorized based on cancer stage (I-IV) and treatment type. QoL scores were analyzed to assess the impact of cancer stage and treatment on physical, emotional, social, and functional domains. Statistical analysis was performed using [insert software], with p<0.05 considered significant. Ethical approval was obtained, and patient confidentiality was maintained.

Patient Demographics and Disease Profile

Most patients fall within the 30–40 age group (33.1%), with a mean age of 47.5 years (range: 34–63), and over half (56.4%) have a disease duration of less than 6 months. While 58.3% report no comorbidities, diabetes mellitus (28.8%) and hypertension (22.1%) are notable, and only 9.9% have a family history of cancer. The data paints a picture of a middle-aged population with recent disease onset, limited genetic risk, and moderate chronic condition prevalence.

Table 1Clinical Presentation and Diagnostics

Stage III dominates (38.6%), with frequent left-side (68.1%) and axillary lymph node involvement (54.6%) on mammography. PET scans are widely used (77.3%), and biopsy reveals invasive carcinoma of no special type as the leading diagnosis (74.8%). IHC highlights a hormone receptor-positive profile (ER+/PR+/Her2neu–ve, 84.0%). The data reflects an advanced-stage population with aggressive diagnostics and a predominantly hormone-sensitive tumor type.

Table 2 Treatment Approaches and Stage Correlation

Over half (57.7%) received neoadjuvant therapy, with MRM as the primary surgery (60.7%) and adjuvant treatment nearly universal (99.4%). Stage I cases are exclusively managed with BCS, Stage II and III lean heavily on MRM, and Stage IV is entirely inoperable. The findings showcase a structured treatment escalation from BCS in early stages to MRM in advanced stages, with comprehensive adjuvant support

Table 3 Post-Treatment Physical and Functional Outcomes

BCS patients lead in physical strength recovery (62.5%), while inoperable cases suffer significantly higher pain (84.4%, p<0.0001) and restricted arm movement (53.1%, p<0.0001). MRM patients frequently experience upper limb swelling (55.6%, p=0.04). The results underscore BCS’s favorable recovery profile and the severe physical toll on inoperable patients.

 Table 4 Psychosocial and Quality of Life Outcomes

Inoperable patients report the highest social support (65.6%, p=0.043) but struggle most with coping (78.1%, p<0.0001). BCS patients enjoy the best quality time (62.5%, p=0.043), while MRM patients face significant incomplete feelings (27.3%, p=0.0003). Quality of life scores peak at 201–300 (50.9%), suggesting moderate well-being for most. The data reveals persistent emotional challenges across groups, with BCS offering psychosocial advantages and inoperable cases facing the heaviest burden.

Our study found a mean age of 47.5 years, younger than the typical median age of 62 for breast cancer diagnosis in the US (Breast Cancer Facts & Statistics 2025). This might indicate earlier detection or different population characteristics, with 33.1% aged 30–40 years. Compared to other studies, Konieczny M.  et al⁹ reported a mean age of 55.4 years, and Sergio Alvarez-Pardo’s et al¹⁰ was 52.9 years, both older, while Akça M. (47.4 years) and Hsiao FH (49.5 years) were closer. This younger age could reflect regional screening practices or awareness campaigns.

Clinical Staging and Treatment

A significant 58.2% of our patients were in advanced stages (Stage III or IV), contrasting with Hsiao FH’s  et al. ¹¹ early-stage focus (90.4% Stages 0–II). This high advanced-stage proportion may result from delayed presentation, possibly due to limited access to screening, as supported by research on factors like socio-demographic barriers and cultural attitudes (Breast Cancer Risk Factors). Treatment escalated from BCS for Stage I to mastectomy for Stages II–III and inoperable for Stage IV, with 99.4% receiving adjuvant therapy.

Quality of Life and Surgical Impact

BCS patients showed better outcomes, with 62.5% regaining physical strength versus 40.4% for mastectomy, aligning with studies like Konieczny M.’s, et al⁹ which found BCS improved physical and sexual functioning. Pain was highest in inoperable patients (84.4%), highlighting the physical toll of advanced disease. This supports the preference for BCS when feasible, as it reduces long-term symptoms, consistent with recent findings (Breast Cancer Surgery’s Impact on Quality of Life).

Comorbidities and Psychosocial Factors

Interestingly, 58.3% had no comorbidities, but diabetes (28.8%) and hypertension (22.1%) were notable, potentially complicating treatment. Social support was highest for inoperable patients (65.6%), possibly due to greater care needs, while BCS patients reported better quality time (62.5%) and lower incomplete feelings (0% vs. 27.3% for mastectomy). This aligns with Hsiao FH’s et al¹¹ emphasis on psychological factors like anxiety affecting quality of life, suggesting integrated care is crucial.

Patient Demographics and Disease Profile

Our study included 163 patients with a mean age of 47.5 years (range: 34–63), with the largest group aged 30–40 years (33.1%), followed by 50–60 years (30.1%), 40–50 years (25.8%), and over 60 years (11.0%). This distribution is younger than typical breast cancer cohorts, where the median diagnosis age is around 62 years in the US (Breast Cancer Facts & Statistics 2025). Over half (56.4%) had a disease duration of less than 6 months, indicating recent diagnoses. Comorbidities were absent in 58.3%, with diabetes mellitus (28.8%) and hypertension (22.1%) being common, and only 9.9% reported a family history of cancer, suggesting a predominantly sporadic profile.

Comparatively, Konieczny M.’s et al⁹ study reported a mean age of 55.4 years, with 32.4% aged 60–75 years, indicating an older cohort possibly reflective of age-related risk factors. Akça M.’s et al¹² study had a mean age of 47.4 years, closely matching ours, but focused on 46–55 years (64.8%). Sergio Alvarez-Pardo’s et al ¹⁰ mean age was 52.9 years, with 56.8% aged 50 or older, while Khazi F’s study peaked at 41–50 years (40.7%). Hsiao FH’s et al¹¹ mean age was 49.5 years, slightly older but within a similar middle-aged range, with a focus on early-stage patients (Stages 0–II: 90.4%). The younger age in our study may suggest earlier detection, potentially due to targeted awareness campaigns or accessible screening, as breast cancer incidence increases with age, particularly after 40 (Breast Cancer Risk Factors).

Clinical Presentation and Diagnostics

Clinical staging in our study showed Stage III dominance (38.6%), followed by Stage II (23.4%), Stage IV (19.6%), and Stage I (18.4%), indicating a significant advanced-disease burden (58.2% Stages III–IV). Mammography revealed frequent left-side involvement (68.1%) and axillary lymph nodes (54.6%), with PET scans widely used (77.3%). Biopsy findings identified invasive carcinoma of no special type as the leading diagnosis (74.8%), and IHC highlighted a hormone receptor-positive profile (ER+/PR+/Her2neu–ve: 84.0%), with 13.5% triple-negative cases.

This advanced-stage predominance contrasts with Hsiao FH’s study, where 90.4% were in early stages, likely due to robust screening practices. Khazi F’s et al¹³ study also reported a high Stage III prevalence (55.4%), aligning with our findings. Sergio Alvarez-Pardo’s et al¹⁰ study didn’t specify stages but noted a high mastectomy rate (64.1%), often associated with advanced disease. Factors influencing late-stage diagnosis include delayed seeking of medical care, socio-demographic barriers (e.g., lower education, income, or lack of insurance), limited access to screening, and cultural or social factors, as supported by recent research (Factors influencing late stage of breast cancer at presentation). Our high advanced-stage proportion may reflect these factors, emphasizing the need for enhanced early detection efforts.

Treatment Approaches and Stage Correlation

Our treatment data showed 57.7% received neoadjuvant therapy, with modified radical mastectomy (MRM) as the primary surgery (60.7%), followed by breast-conserving surgery (BCS) (19.6%) and inoperable cases (19.6%). Adjuvant treatment was nearly universal (99.4%). Stage-wise, BCS was exclusive to Stage I (30 cases), MRM dominated Stages II (36) and III (63), and Stage IV was entirely inoperable (32), reflecting a structured escalation from BCS in early stages to MRM in advanced stages.

Konieczny M.’s et al⁹ study favored BCT (51.4%) over mastectomy (48.6%), contrasting with our MRM dominance, possibly due to earlier stages or patient preferences. Sergio Alvarez-Pardo’s 64.1% mastectomy rate aligns with our advanced-disease focus. Hsiao FH et al¹¹ reported 67.5% BCS, reflecting their early-stage cohort, with 50.6% chemotherapy and 48.2% radiotherapy, differing from our near-universal adjuvant use (99.4%). Khazi F et al¹³ emphasized chemotherapy (64.9%) over surgery (16.6%), suggesting a distinct systemic approach. These variations highlight diverse practice patterns and the need for individualized treatment plans.

Post-Treatment Physical and Functional Outcomes

Post-treatment outcomes revealed BCS patients leading in physical strength recovery (62.5%) compared to MRM (40.4%) and inoperable cases (37.5%, p=0.06). Pain was significantly higher in the inoperable group (84.4%) versus MRM (30.3%) and BCS (25%, p<0.0001), as was restricted arm movement (53.1% vs. 5.1% MRM, 0% BCS, p<0.0001). Upper limb swelling was more frequent in MRM (55.6%) than BCS (31.3%) or inoperable cases (43.8%, p=0.04). Skin changes and household difficulties showed no significant differences (p=0.78, p=0.17).

These findings align with Konieczny M.’s, et al⁹ where BCT patients outperformed mastectomy patients in physical functioning (p<0.01), and Akça M.’s, which found better outcomes with BCS. Sergio Alvarez-Pardo noted better general health with mastectomy but worse nausea and vomiting, contrasting our MRM group’s swelling and pain burden. Hsiao FH’s longitudinal data showed physical function improvements over 14 months, though breast-specific issues persisted, consistent with our BCS patients’ fewer limitations versus MRM’s ongoing challenges. Recent literature confirms BCS generally offers better long-term quality of life, particularly in physical functioning and symptom management (Breast Cancer Surgery’s Impact on Quality of Life).

Psychosocial and Quality of Life Outcomes

Psychosocial data showed inoperable patients receiving the most social support (65.6%, p=0.043), possibly due to greater care needs, while BCS patients reported the best quality time (62.5%, p=0.043). MRM patients faced significant incomplete feelings (27.3%, p=0.0003), and decreased sexual interest was similar across groups, slightly higher in inoperable (31.2%). Quality of life scores peaked at 201–300 (50.9%), indicating moderate well-being.

Konieczny M.’s et al⁹ BCT patients scored higher in sexual functioning and satisfaction (p<0.01) than mastectomy patients, aligning with our BCS group’s trends. Akça M. et al¹² found MRM linked to poorer body image (p<0.001) and future perspectives (p<0.002), echoing our MRM patients’ incomplete feelings. Sergio Alvarez-Pardo’s et al high unemployment (71.6%) suggests socioeconomic strain, contrasting our variable social support. Hsiao FH noted emotional function improvements post-fifth month, though sexual aspects remained static, consistent with our persistent sexual interest challenges. Recent studies highlight psychosocial interventions, such as supportive psychotherapy and cognitive behavioral therapy, as effective in reducing distress and improving quality of life, particularly for advanced-stage patients (Psychosocial Needs of Women with Breast Cancer).

Summary Tables

Below are tables summarizing key findings for comparison:

Table 1: Age Distribution Comparison

Table 2: Clinical Staging and Treatment

This retrospective study highlights the significant impact of breast cancer stages and treatment modalities on patients' quality of life (QOL). Key findings reveal that patients undergoing Breast Conservative Surgery (BCS) reported better physical recovery (62.5% regained strength) and lower pain levels (25%) compared to those receiving Modified Radical Mastectomy (MRM) (40.4% strength recovery; 30.3% pain) and inoperable/palliative groups (37.5% strength recovery; 84.4% pain). Advanced-stage (III/IV) and inoperable patients faced pronounced psychological distress, including fear of recurrence and diminished social functioning. The study underscores the importance of tailored treatment approaches, with BCS offering superior QOL outcomes when feasible. However, limitations such as a small sample size and single-center design necessitate further multicenter, longitudinal research. Practical recommendations include integrating psychosocial support, enhancing patient-provider communication, and adopting multidisciplinary care to address both physical and emotional challenges in breast cancer management.

1. Simon A, Robb K. Breast Cancer. Cambridge Handbook of Psychology, Health and Medicine, Second Edition [Internet]. 2024 Feb 25 [cited 2024 Sep 11]; 577–80. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482286/
2. Admoun C, Mayrovitz HN. The Etiology of Breast Cancer. Breast Cancer [Internet]. 2022 Aug 6 [cited 2024 Sep 11];21–30.        
3. Ross DS, Pareja F. Molecular Pathology of Breast Tumors: Diagnostic and Actionable Genetic Alterations. Surg Pathol Clin [Internet]. 2021 Sep 1 [cited 2024 Sep 11];14(3):455. Available from: /pmc/articles/PMC8363111/
4. Orrantia-Borunda E, Anchondo-Nuñez P, Acuña-Aguilar LE, Gómez-Valles FO, Ramírez- Valdespino CA. Subtypes of Breast Cancer. Breast Cancer [Internet]. 2022 Aug 6 [cited 2024 Sep 11];31–42. Available from: https://www.ncbi.nlm.nih.gov/books/NBK583808/
5. Wang L. Early Diagnosis of Breast Cancer. Sensors 2017, Vol 17, Page 1572 [Internet]. 2017 Jul 5 [cited 2024 Sep 11];17(7):1572. Available from: https://www.mdpi.com/1424- 8220/17/7/1572/htm
6. Winchester DP, Cox JD. Standards for diagnosis and management of invasive breast carcinoma. American College of Radiology. American College of Surgeons. College of American Pathologists. Society of Surgical Oncology. CA Cancer J Clin. 1998 Mar 1;48(2):83–107.
7. Heidary Z, Ghaemi M, Hossein Rashidi B, Kohandel Gargari O, Montazeri A. Quality of Life in Breast Cancer Patients: A Systematic Review of the Qualitative Studies. Cancer Control [Internet]. 2023  Jan  1  [cited  2024  Sep  11];30:1–10.  Available  from:/pmc/articles/PMC10236425/
8. Koller M, Lorenz W. Quality of life: a deconstruction for clinicians. J R Soc Med [Internet]. 2002 Oct 1 [cited 2024 Sep 12];95(10):481. Available from: /pmc/articles/PMC1279172/
9. Konieczny M, Fal A. The Influence of the Surgical Treatment Method on the Quality of Life of Women With Breast Cancer. Eur J Breast Health. 2023 Apr 1;19(2):121-127. doi: 10.4274/ejbh.galenos.2023.2022-9-1. PMID: 37025576; PMCID: PMC10071887.
10. Alvarez-Pardo, S.; Romero-Pérez, E.M.; Camberos-Castañeda, N.; de Paz, J.A.; Horta-Gim, M.A.; González-Bernal, J.J.; Mielgo-Ayuso, J.; Simón-Vicente, L.; Fernández-Solana, J.; González-Santos, J. Quality of Life in Breast Cancer Survivors in Relation to Age, Type of Surgery and Length of Time since First Treatment. Int. J. Environ. Res. Public Health 2022, 19, 16229. https://doi.org/10.3390/ ijerph192316229
11. Hsiao FH, Kuo WH, Jow GM, Wang MY, Chang KJ, Yu Ming Lai, et al. The changes of quality of life and their correlations with psychosocial factors following surgery among women with breast cancer from the post-surgery to post-treatment survivorship. The Breast. 2019 Apr 1;44:59–65.
12. Akça M, Ata A, Nayır E, Erdoğdu S, Arıcan A. Impact of Surgery Type on Quality of Life in Breast Cancer Patients. J Breast Health. 2014 Oct 1;10(4):222-228. doi: 10.5152/tjbh.2014.1919. PMID: 28331675; PMCID: PMC5351519
13. Khazi F, Mubashir Angolkar, Kumari S, Patil BR. Assessment of quality of life among breast cancer patients undergoing different Treatment Modalities at tertiary hospitals in north Karnataka, India. Clinical Epidemiology and Global Health. 2024 Jul 1;28:101675–5.