(014) Predictors of Sexual Health and Body Image Change Among Young Women with Breast Cancer: A Multivariate Analysis

Abstract Introduction Young women with breast cancer often develop premature menopause and sexual distress, which negatively impact QoL. Although declines in sexual health during treatment are recognized, there is limited understanding of factors that predict improvement over time. This study prospectively examines changes in sexual interest, satisfaction, desire, body image, and emotional distress among women ≤45. It identifies predictors of improvement using multivariate analysis (MVA). Objective To characterize six-month changes in emotional and sexual wellbeing in breast cancer patients and identify predictors of improvement through MVA. Methods From May 2023 to February 2025, women ≤45 completed online surveys at diagnosis and six months into treatment as part of MSKCC’s Young Women with Breast Cancer Program (YWBCP). Surveys assessed sexual interest, satisfaction, desire, body image, anxiety, and distress. Paired analysis evaluated within-subject changes over time. Multivariable logistic regression models identified demographic and treatment predictors of improvement, reported as odds ratios (OR) with 95% confidence intervals (CI), adjusting for age, treatment type, and marital status. Results 1222/1678 (72.8%) completed the intake and 404/746 (54.2%) the six-month survey; mean age was 39 (range 19–45). Paired analysis (n = 273) shows 34% (n = 89) decreased interest in sexual activity at 6 months compared to baseline, while 25% (n = 65) improved and 41% (n = 109) remained unchanged. 53%, (n = 135) had decreased satisfaction, and 47% (n = 127) reported poorer body image at 6-months. 52% (n = 139) had decreased appreciation for their body’s uniqueness. MVA showed older age was significantly associated with improvement in sexual interest (OR = 1.16, 95% CI 1.05–1.29, p = 0.004) and satisfaction (OR = 1.21, 95% CI 1.09–1.38, p = 0.001) at 6 months. Married or partnered participants had lower odds of improving sexual satisfaction at six months compared with single participants (OR = 0.35, 95% CI 0.14–0.83, p = 0.019). Chemotherapy was associated with worse satisfaction (OR = 0.34, 95% CI 0.13–0.85, p = 0.024), sexual desire (OR = 0.29, 95% CI 0.11–0.74, p = 0.011), and distress (OR = 0.16, 95% CI 0.03–0.66, p = 0.015) at six months. No significant predictors were observed for good body image. Surgical treatment was not a significant predictor of sexual health outcomes, however, compared with lumpectomy + SLNB, patients who underwent mastectomy + ALND has worse distress levels (OR = 0.10, 95% CI 0.01–0.96, p = 0.042). For anxiety, patients who have not yet had breast surgery demonstrated more anxiety (OR = 0.29, 95% CI 0.09–0.96, p = 0.044) compared with lumpectomy + SLNB patients. Conclusions Over half of young women reported decreased sexual satisfaction and nearly half reported poorer body image 6 months into treatment. Older age and certain surgical approaches were associated with improvement in sexual heath, body-image, and emotional domains, whereas partnered status and chemotherapy were associated with worse outcomes. These findings highlight the importance of early, individualized interventions to support sexual wellbeing, relationships, and psychosocial health in young women throughout breast cancer treatment. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Bayer Pharmaceuticals, Revision Skincare, Shook, Hardy and Bacon LLP, Sprout Pharmaceuticals, TerSera Therapeutics LLC.