Mastectomy and reconstructive surgery may lead to patients becoming persistent drug users

December 09, 2020

SAN ANTONIO - Women who receive mastectomy and reconstructive surgery as part of breast cancer treatment may face the risk of developing persistent use of opioids and sedative-hypnotic drugs, according to data presented at the 2020 San Antonio Breast Cancer Symposium, held Dec. 8-11.

"It has become clear that short-term exposure to opioids for any reason can lead to long-term dependence, given the highly addictive potential of these agents," explained the study's lead author, Jacob Cogan, MD, a fellow in hematology/oncology at NewYork-Presbyterian/Columbia University Irving Medical Center in New York. "Many patients receive this initial exposure around the time of surgery, and patients with cancer are at particularly high risk of becoming dependent on opioids post-operatively."

Cogan added that another class of addictive medications, sedative-hypnotics, are frequently prescribed to patients with cancer, but have received less attention relative to opioids. Patients with cancer may receive sedative-hypnotic prescriptions around the time of surgery to combat anxiety or insomnia. In this study, he and colleagues aimed to assess breast cancer patients' risk of becoming dependent on opioids and/or sedative-hypnotic drugs after mastectomy with reconstruction surgery.

Researchers used the MarketScan health care claims database to evaluate women who underwent mastectomy and reconstruction between 2008 and 2017. They identified prescriptions for opioids and sedative-hypnotics during three time periods: the pre-operative period (365 days to 31 days prior to surgery); the peri-operative period (31 days prior to 90 days after their surgery); and the post-operative period (90 days to 365 days after surgery).

The researchers identified 25,270 women who were not prior users of opioids and 27,651 who were not prior users of sedative-hypnotics. Patients who had no use in the first time period but filled at least one prescription in the perioperative period and at least two prescriptions in the post-operative period were considered new chronic users.

Results showed that 13.1 percent of opioid-naive patients become new persistent opioid users after mastectomy and reconstruction. Meanwhile, 6.6 percent of sedative-hypnotic-naive patients become new persistent sedative-hypnotic users. When removing "non-user" patients from these groups (i.e., those who did not receive or fill a perioperative controlled substance prescription), the rates rose to 17.5 percent and 17 percent, respectively.

The study also found that the chance of becoming a persistent user of both types of controlled substances was significantly increased among women under age 60, those with a breast cancer diagnosis (versus those who had prophylactic surgery), and those treated with chemotherapy. As the number of risk factors increased, the risk of becoming a persistent user also increased.

"I hope that our study can increase awareness that these are addictive medications, and a brief exposure for surgery-related pain or anxiety can lead to long-term use," Cogan said. "Both patients and providers should be aware of this issue, and of the risk factors that elevate an individual patient's risk."

Cogan said the study results do not suggest that opioids and sedative-hypnotic drugs should be avoided. "Rather, patients should be vigilant about taking these medications only when necessary, and they should work closely with the prescribing provider to attempt to minimize risk of dependence," he said.

Cogan noted that a limitation of the study is that it is based on claims that providers submitted to insurance companies. These may not be fully accurate and are not submitted in a uniform fashion from provider to provider.
This study was funded by the Breast Cancer Research Foundation and the National Institutes of Health. Cogan declares no conflicts of interest.

About the San Antonio Breast Cancer Symposium

Since 1977, the San Antonio Breast Cancer Symposium® (SABCS®) has been the leading scientific conference for basic scientists, physician-scientists, clinical investigators and breast care providers, and advocates seeking an exchange of new information in experimental biology, etiology, prevention, diagnosis, and therapy of premalignant breast disease and breast cancer. Founded, owned, and operated by UT Health San Antonio, the symposium has grown to a five-day event attended by an international audience of academic investigators and private physicians from over 80 countries to attain information through abstract presentations, panel discussions, research findings, and state-of-the-art educational sessions. UT Health San Antonio, with co-sponsors the Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine and the American Association for Cancer Research, supports SABCS, which provides education and accessibility to the latest information regarding the prevention, diagnosis, and treatment of premalignant breast cancer and breast disease. For more information on SABCS, visit

To interview Jacob Cogan, please contact Julia Gunther at or 770-403-7690.

American Association for Cancer Research

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 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