Outcomes of a prospective cohort study of PREoperative therapy and supportive care in early & locally advanced breast cancers—PreSCella study

Why this study matters to everyday people

For many women, a breast cancer diagnosis comes with not just medical decisions, but life-changing questions about body image, family roles, independence, and intimacy. This study from Singapore followed women before, during, and after intensive pre-surgery treatment to ask a simple but often neglected question: how do they actually feel and cope over time—and how can care be tailored to women at very different ages?

A closer look at treatment before surgery

Modern breast cancer care often starts with powerful drugs given before the tumor is removed, a strategy called preoperative or “neoadjuvant” therapy. It can shrink cancers, open the door to breast-conserving surgery, and guide later treatment choices. But it is also demanding: women must navigate scans, biopsies, heart tests, fertility counselling, genetic clinics, and multiple specialists in a short time. In Singapore’s largest public health cluster, a coordinated program was built so that a dedicated nurse helps patients move smoothly through this maze, arranging rapid access to genetic testing, fertility advice, heart checks, psychological support, and age-specific services. The PreSCella study used this real-world program as a living laboratory to see how women’s quality of life and support needs change from diagnosis to one year later.

Following women’s lives over a year

Researchers enrolled 235 women with early or locally advanced breast cancer who were being treated with pre-surgery therapy at three hospitals. They measured quality of life at three key moments: before treatment started, shortly after breast surgery, and about one year after diagnosis. All women filled out a detailed questionnaire covering physical symptoms, emotional health, daily functioning, family and social support, and breast-cancer-specific concerns. Younger women under 40 answered extra questions on body image, partner relationships, and sexual function. Women over 65 completed tools that probed how they weighed length of life against comfort, independence, and symptom control. By repeatedly checking in, the team could see not just snapshots, but how experiences rose and fell across the treatment journey.

What improved and what did not

On average, women’s overall quality of life held steady through the hardest months and clearly improved by the one-year mark. Emotional well-being climbed the most, suggesting that once treatment was underway and surgery completed, many women felt less fear and distress and more sense of “returning to normal.” Physical and day-to-day functioning also recovered over time, while feelings tied directly to having breast cancer—such as worry about the breast, scars, and treatment side effects—eased. Social and family support stayed relatively constant, hinting that loved ones continued to be a stable source of strength. Younger women had, on the whole, mild body image distress, likely helped by higher rates of breast-conserving surgery or reconstruction. Their relationships with partners generally remained strong. However, among those who were sexually active, sexual function fell sharply after surgery and treatment and only partially recovered by one year, leaving many still struggling with desire, comfort, and satisfaction.

What older women value most

For women over 65, the study turned the spotlight on what really matters when they face cancer treatment decisions. Many said that, if forced to choose, they would rather have better day-to-day quality of life than simply live as long as possible. About half preferred feeling well now to banking on future benefits, and many expected their quality of life to worsen over the next year or five years despite treatment being aimed at cure. When asked to rank outcomes, maintaining independence—being able to think clearly, move about, and care for themselves—outweighed even living longer. Relief from pain and other symptoms also ranked highly. These findings suggest that older patients may quietly worry about their ability to age well, even when doctors are focused on beating the cancer.

What this means for future care

This study shows that carefully organized pre-surgery treatment, paired with strong support services, can help many women come through an intense year of breast cancer care with their overall quality of life not only preserved but improved—especially emotionally. At the same time, it exposes blind spots: younger women may need much more help with sexual well-being, while older women may need honest conversations and practical support focused on independence and comfort, not just survival. By listening to women at different ages and across the whole treatment journey, the PreSCella study argues for a simple but powerful shift: breast cancer care should not only aim to save lives, but also to match treatment and supportive care to what matters most to each woman.

Citation: Lee, H.Y., Ong, W.S., Tan, J.Y.T. et al. Outcomes of a prospective cohort study of PREoperative therapy and supportive care in early & locally advanced breast cancers—PreSCella study. npj Breast Cancer 12, 32 (2026). https://doi.org/10.1038/s41523-026-00898-0

Keywords: breast cancer, quality of life, neoadjuvant therapy, supportive care, age-specific care