EORTC QLQ-BR23: Quality of Life in Breast Cancer
European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire—Breast Cancer Module · Also known as: QLQ-BR23
The EORTC QLQ-BR23 is a 23-item breast-cancer-specific module designed to complement the 30-item EORTC QLQ-C30 core questionnaire, assessing functional and symptom domains unique to breast cancer. Validated by Sprangers et al. in 1996, it measures body image, sexual function, breast symptoms, and arm symptoms, making it a standard instrument in European and international breast cancer clinical trials and quality-of-life research.
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When to use it
EORTC QLQ-BR23 is indicated for women with breast cancer (any stage, any treatment) undergoing surgery, radiation, chemotherapy, endocrine therapy, or HER2-targeted therapy. Primary use is clinical trials assessing treatment efficacy and patient-reported outcomes, particularly European and international cooperative groups; secondary use in oncology clinic monitoring and supportive care research. NOT for screening or diagnosis. Particularly valuable when treatment decisions involve cosmetic/functional trade-offs (e.g., breast-conserving therapy vs. mastectomy, axillary lymph node dissection vs. sentinel node biopsy, adjuvant chemotherapy tolerance).
Strengths & limitations
- Breast-cancer-specific scales directly measure body image, sexual function, and arm/breast symptoms—critical domains in breast cancer QoL not captured by generic scales.
- Detailed symptom assessment (breast symptoms, arm symptoms, systemic therapy side effects) enables targeted symptom management.
- Extensively validated in large, diverse breast cancer populations across treatment modalities and stages; robust psychometric properties.
- Translated into 80+ languages; international standard in breast cancer research, particularly in Europe and beyond.
- Used as gold standard in major breast cancer cooperative trials (EORTC, BIG, IBCSG, ASCO); high regulatory credibility.
- Relatively long (23 items) when added to QLQ-C30 core (53 items total); may cause respondent fatigue in clinical practice.
- Body image and sexual function scales have few items (1–3 each), potentially limiting nuance in assessment.
- Sexual enjoyment scale is single-item only; lacks granularity for detailed sexual dysfunction phenotyping.
- Does not directly assess cosmetic satisfaction (overall satisfaction with surgical result) or appearance-related distress beyond body image items.
Frequently asked
How does EORTC QLQ-BR23 compare to FACT-Breast cancer scales?
EORTC QLQ-BR23 (23 items added to QLQ-C30) uses 4-point Likert scales and yields separate functional/symptom scales (0–100 each). FACT-B (FACT-Breast) is less commonly used than FACT extensions in other cancers; QLQ-BR23 is the standard in European/international trials. Both are valid; QLQ-BR23 is more prevalent globally and in cooperative group research.
What is the minimal clinically important difference (MCID) for QLQ-BR23 scales?
MCID for most QLQ-BR23 scales is approximately 10–15 points on the 0–100 scale. However, MCID varies by scale and population. Body image and arm symptom scales may have different MCID thresholds. In trials, MCID contextualizes statistical significance and determines clinical meaningfulness of treatment effects. Always consult trial-specific guidance or published MCID estimates for your specific scale and population.
Can QLQ-BR23 be used in male breast cancer patients?
QLQ-BR23 has limited validation in male breast cancer (rare disease, small patient numbers in validation cohorts). Sexual function and body image items may be less relevant or interpreted differently in men. If using QLQ-BR23 in male breast cancer, acknowledge limitation and consider supplementary male-specific assessment or qualitative exploration of body image and sexual concerns.
How are missing data handled in QLQ-BR23 scoring?
EORTC scoring guidelines: if >50% of items in a scale are missing, do not score that scale. If ≤50% are missing, impute the mean of completed items. Report data completeness. Avoid interpretation if critical scales have substantial missing data.
Is QLQ-BR23 appropriate for breast cancer survivors in long-term follow-up?
Yes. QLQ-BR23 is valid at any time post-diagnosis, including long-term survivors (5+ years). Interpretation should account for time from treatment; late-stage survivors may have low arm symptom and breast symptom scores if disease-free, but body image and sexual function may persist. Longitudinal QLQ-BR23 tracking can identify emerging late effects and guide survivorship interventions.
Is QLQ-BR23 freely available in multiple languages?
QLQ instruments are copyrighted by EORTC but available for non-commercial research use. Registration and use agreement required (available via EORTC Quality of Life Group, qlg.eortc.be). Validated translations in 80+ languages are available through official channels. Use licensed versions to ensure psychometric integrity.
Sources
- Sprangers, M. A., Groenvold, M., Arraras, J. I., Franklin, J., te Velde, A., Muller, M., et al. (1996). The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol, 14(10), 2756–2768. DOI: 10.1200/JCO.1996.14.10.2756 ↗
- Aaronson, N. K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., et al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 85(5), 365–376. DOI: 10.1093/jnci/85.5.365 ↗
How to cite this page
ScholarGate. (2026, June 3). European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire—Breast Cancer Module. ScholarGate. https://scholargate.app/en/oncology/eortc-qlq-br23
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