Double Mastectomy Results in Many Missed Work Days

Patients who choose more aggressive surgery for early-stage breast cancer are 8 times more likely to miss work days, according to a new study published by Cancer.

As more patients with breast cancer are choosing to undergo double mastectomy, it is important to understand the potential impacts on employment.

Included in the study were 1006 employed women treated for early-stage breast cancer. Of these patients, 19% received a bilateral mastectomy with reconstruction. Patients were tracked to determine whether their treatment affected their ability to work.

The authors found that chemotherapy, race, and employment support all affected whether patients lost more than a month of work days or completely stopped working altogether.

Significantly, patients who underwent a bilateral mastectomy with reconstruction had a 7.8 times greater risk of missing more than a month of work or stopping work compared with patients with received a lumpectomy and radiation, according to the study.

“It really stood out, especially because bilateral mastectomy has not been demonstrated to improve survival and clearly has a negative impact on employment,” said lead study author Reshma Jagsi, MD. “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.”

Previous studies have examined the impact of cancer treatment on employment and suggested that chemotherapy may lead to the most work days lost; however, changes in disease management have moved away from chemotherapy for early-stage breast cancer, according to the current study.

“But as we’ve had success reducing overtreatment with chemotherapy, we’re now seeing a paradoxical increase in what may be overtreatment with surgery,” Dr Jagsi said. “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.”

The authors suggest that physicians should communicate data to patients in a way that supports their decisions but also highlights the potential negatives of mastectomy, according to the study.

“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,’” Dr Jagsi said. “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 increasing prevalence of mastectomy—partially due to celebrities undergoing the treatment and patient interest—additional studies are needed to determine whether short-term effects on employment translate to sustained effects on employment and quality of life, according to the study.

“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,” Dr Jagsi said. “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.”