Sexual functioning, sexual enjoyment, and body image in Norwegian breast cancer survivors: a 12-year longitudinal follow-up study and comparison with the general female population

Given the scarcity of evidence concerning the long-term sexual health of breast cancer (BC) survivors (BC-Pop), we aimed to assess how BC treatments affect short- and long-term sexual functioning, sexual enjoyment, and body image, and compare with aged-matched women in the Norwegian general population (F-GenPop). The 349 patients in BC-Pop treated at Trondheim University Hospital in 2007–2014, were assessed in clinical controls at the hospital; before starting radiotherapy (T1, baseline), immediately after ending radiotherapy (T2), and after 3, 6, and 12 months (T3–T5), and at a long-term follow-up 7–12 years after baseline (T6). Meanwhile, F-GenPop included 2254 age-matched women in the Norwegian general population. The impact of BC treatment on sexual functioning was examined using a Linear Mixed Model. Sexual functioning, sexual enjoyment, and body image were assessed with the EORTC′s QLQ-BR23 scales and compared between the populations in the four age groups (30–49, 50–59, 60–69, and 70+ years) using means with 95% confidence intervals and Student <i>t</i>-test. Linear regression, adjusted for age and comorbidity was applied to estimate individual scores. BC survivors treated with mastectomy had overall lower sexual functioning than patients who had received breast-conserving surgery (<i>p</i> = 0.017). Although BC survivors treated with chemotherapy had lower sexual functioning than those treated without chemotherapy at T1–T5 (<i>p</i> = 0.044), both groups showed the same level of functioning at T6. BC-Pop exhibited significantly poorer sexual functioning (<i>p</i> &lt; 0.001), lower sexual enjoyment (<i>p</i> &lt; 0.05), and better body image (<i>p</i> &lt; 0.001) than F-GenPop in all age groups. The impact of specific BC treatments on sexual functioning was modest; only mastectomy had a persistent negative influence. Nevertheless, all age groups in BC-Pop displayed significantly poorer sexual functioning than F-GenPop at both 12 months and up to 12 years after treatment.