Double mastectomy, an aggressive surgical procedure to remove both breasts, increases the chances that early stage breast cancer patients will miss work for longer periods or stop working entirely, a new study found.
However, the treatment is not linked to better survival rates, prompting researchers to suggest that employment and other quality of life factors should be considered by doctors and patients when choosing the best surgical approach.
The study titled, “Treatment decisions and employment of breast cancer patients: Results of a population-based survey,” was published in the journal Cancer.
A cancer diagnosis has a severe impact on a person’s life, affecting not only their health, but also their social functioning and emotional well-being. For many patients, employment is not only a source of income, but also a way to give life meaning, to provide a welcome distraction, and to improve quality of life.
Thus, it is important that treatments be evaluated not only for their effectiveness, but also for the impact they have on a patient’s quality of life.
Researchers at the University of Michigan Comprehensive Cancer Center evaluated how surgical treatment impacted the employment experiences of women with early-stage breast cancer.
The team surveyed 1,006 women, ages 20 to 79, who were diagnosed from 2014-2015 and employed at the time. The majority (84%) were working full-time.
Most patients (62%) had undergone a breast-conserving surgery called lumpectomy that only removes the tumor and surrounding tissue. An additional 16% underwent unilateral mastectomy — the full removal of the affected breast — with 8% having breast reconstruction. The remaining 23% underwent bilateral mastectomy, with 19% of those having breast reconstruction.
The analysis revealed that treatment with chemotherapy, race, and supportive policies at work — such as paid sick leave, flexible schedules, and disability benefits — significantly affected whether a patient would miss more than a month of work or stop working entirely after treatment.
Patients with more employee benefits were less likely to miss work or leave altogether. Black patients were nearly two times more likely to have work affected than white patients.
Surgical treatment also influenced the likelihood of missing work or leaving it altogether. Women who underwent bilateral mastectomy and reconstruction were 7.8 times more likely to miss work for more than one month, compared to patients treated with lumpectomy. They were also 3.1 times more likely to stop working.
“It really stood out, especially because bilateral mastectomy has not been demonstrated to improve survival, and clearly has a negative impact on employment,” Reshma Jagsi, MD, professor and deputy chair of radiation oncology at Michigan Medicine and lead author of the study, said in a news release.
“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,” she said.
Chemotherapy, the prior standard of care for most breast cancer cases, was also seen to induce longer work disruptions or loss of employment. Currently, other treatment approaches are seen as more suitable for early-stage breast cancer patients.
“But as we’ve had success reducing overtreatment with chemotherapy, we’re now seeing a paradoxical increase in what may be overtreatment with surgery,” said 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.”
Doctors need to better communicate with patients by providing all of the information about treatments under consideration, researchers concluded. Understanding all of the unexpected downsides of a treatment may improve a patient’s autonomy when choosing the best approach.
“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,” Jagsi said.
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