Study finds double mastectomy tied to more missed work

October 09, 2017

ANN ARBOR, Michigan -- Women who pursue a more aggressive surgery for early stage breast cancer have nearly eight times the odds of reporting substantial employment disruptions, according to a new study from University of Michigan Comprehensive Cancer Center researchers.

The study, published in Cancer, surveyed 1,006 women who were treated for early stage breast cancer and were employed at the time of their diagnosis. Use of chemotherapy, race and differences in employment support - including paid sick leave and flexible working schedules - all had an impact on whether women lost more than a month of work or stopped working entirely after treatment.

But the most striking statistic in the study results came from the 19 percent of women who had bilateral mastectomy with reconstruction, a procedure that offers little to no benefit for women at low risk for developing a second cancer.

The women in the study who opted for a bilateral mastectomy with reconstruction had 7.8 times the odds of missing more than a month of work or stopping work altogether, compared to women who opted for a lumpectomy and radiation therapy.

"It really stood out, especially because bilateral mastectomy has not been demonstrated to improve survival, and clearly has a negative impact on employment," says lead study author Reshma Jagsi, M.D., professor and deputy chair of radiation oncology at Michigan Medicine. "It's not clear that this association between surgical treatment aggressiveness and employment experience is something that is making its way into the discussions that physicians have with patients about the full range of risks and benefits of their treatment decisions."

Prior studies that examined the impact of cancer treatment decisions on employment showed that patients who received chemotherapy were most likely to experience longer disruptions in or loss of employment, but changes in breast cancer management in recent years have shifted recommendations away from chemotherapy for early stage breast cancer.

"But as we've had success reducing overtreatment with chemotherapy, we're now seeing a paradoxical increase in what may be overtreatment with surgery," says Jagsi. "We're seeing more and more women choosing a much more aggressive surgical treatment that isn't clinically mandatory and doesn't improve survival, often for peace of mind."

Jagsi says that clinicians need to learn to communicate with patients in a way that supports their autonomy, but also use data to communicate that there may be unexpected downsides to the treatment they are considering.

"So when a woman walks into a consultation saying 'I really want to remove both of my breasts,' the role of the physician is to say 'I hear you, I will support you, we will do what you ultimately decide to do,'" says Jagsi. "But they also need to make sure the patient is aware of all the options available to her, and the relative risks and benefits."

With the growing use of mastectomy, fueled by celebrity disclosures and growing patient interest, further research is necessary to monitor whether the short-term employment consequences seen in this study will translate into longer term impacts on these women's employment and well-being, say the study authors.

"We also need to develop formal training modules for physicians and surgeons who are treating people with cancer to understand how to begin conversations about employment effects and incorporate those into our routine discussions," says Jagsi. "It doesn't mean that every woman who learns of these study findings is going to choose not to have a bilateral mastectomy, but it is important to make sure that those who do choose that treatment course are fully informed."
-end-
Additional authors: Paul Abrahamse, Kamaria L. Lee, Lauren P. Wallner, Nancy K. Janz, Ann S. Hamilton, Kevin C. Ward, Monica Morrow, Allison W. Kurian, Christopher R. Friese, Sarah T. Hawley,and Steven J. Katz.

Funding: The research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award P01 CA163233.

Disclosure: None

Reference: CANCER; Published Online: October 9, 2017 (DOI: 10.1002/cncr.30959).

Resources:

University of Michigan Comprehensive Cancer Center, http://www.mcancer.org

Michigan Medicine Cancer AnswerLine, 800-865-1125

Michigan Health Lab, http://www.MichiganHealthLab.org

Michigan Medicine - University of Michigan

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.