The BREAST-Q is a breast surgery specific PROM that was developed in adherence with international guidelines for PRO instruments to assess patients’ satisfaction, health-related quality of life (HRQoL), and experience of their care which was developed in 2009.

This is a PROM that measures HRQol and patient satisfaction in the context of breast surgery (mastectomy, reconstruction, breast conservation, augmentation, reduction).

Currently, the BREAST-Q includes augmentation, reduction (mastopexy), and breast cancer-related modules. Moreover, this PROM is continuing to evolve with time and experience as an additional, so-called “health utility module” is in development.

There are currently 6 BREAST-Q modules. The Breast Cancer module (comprised of 4 of the 6 modules) is designed to provide clinicians and researchers the ability to tailor their own version of the questionnaire to suit their individual needs. Each module is divided into multiple scales that can be used independently (Q-Portfolio.org). 2

The scales are psychometrically linked across the various modules and patient treatment groups, and can thus be used for comparison between different patient groups.

  1. Augmentation
  2. Reduction/Mastopexy
  3. Breast Cancer
  • Mastectomy Module
  • Reconstruction Module
  • Breast Reconstruction Expectations Module
  • Breast-Conserving Therapy (BCT) Module

The BREAST-Q is a self-administered questionnaire. Each scale takes 1-4 minutes to complete and an entire BREAST-Q module can be completed in about 10-15 minutes.3

Evaluation of the BREAST-Q

The score takes into account the psychosocial, sexual, and emotional aspects of undergoing surgical interventions, all of which are not immediate concerns in oncology treatment regimes but have an impact on patients’ everyday lives.

There is no overall or total BREAST-Q score, but scores exist for each independent scale. All BREAST-Q scales are transformed into scores that range from 0-100, independent of the type and number of modules. The scores are computed by adding the response items together and then converting the raw sum scale score to a score from 0-100. For all BREAST-Q scales, a higher score means greater satisfaction or better QOL (depending on the scale). If missing data is less than 50% of the scale’s items, insert the mean of the completed items.2

For ease of use, there are tables for this purpose with an additional online program provided by Q-Portfolio.

Strengths

Learnings from the utilization of the BREAST-Q include a demonstrated higher patient satisfaction with silicone implants compared to saline-filled implant cushions.

There are several large-scale studies and surveys that use the BREAST-Q. Atisha et al. conducted a study using the Love/Avon Army of Women program. The cross-sectional study surveyed women who had previously undergone surgery for breast cancer to compare different reconstructive procedures and how satisfaction changes over time for specific patient populations. A total of 7,619 patients completed the BREAST-Q, electronically with an 82% response rate. Women who underwent autologous tissue reconstruction reported the highest breast satisfaction, whereas those who underwent a mastectomy without reconstruction reported the lowest.4

Important opinion leaders like the International Consortium for Health Outcomes Measurement (ICHOM) made the BREAST-Q part of their Breast Cancer Standard PROM Set highlighting that the insights derived from BREAST-Q usage are worth including inpatient care. The BREAST-Q can be covered via the outcome measurement platform heartbeat ONE.

Limitations

Whilst BREAST-Q can measure the associated HRQoL post-operatively, shortcomings have also been observed. Eltahir et al, reported that the BREAST-Q in combination with the aesthetic rating Strasser score only partially reflected women’s satisfaction with their reconstruction surgery.5

Unfortunately, however, there are currently no better tools for understanding women’s preferences or needs. And so, prospective research is therefore needed to enhance such tools for cosmetic outcomes.5

License

The BREAST-Q is owned by Memorial Sloan Kettering Cancer Centre and the University of British Columbia.2

Our PRO consultants will be happy to provide you with more detailed information on how to use the BREAST-Q via the heartbeat ONE platform.

Conclusion

The BREAST-Q has been used to study breast surgery providing meaningful and reliable information regarding HR-QOL and patient satisfaction when used in clinical practice, in surgical research, and quality improvement initiatives.6