Double mastectomy can have negative impact on employment

New York: Women who pursue an aggressive surgery called double mastectomy that involves removing both breasts for early stage breast cancer have higher chances of missing more than a month of work or stopping work altogether, says a study led by an Indian-origin researcher.

Fuelled by celebrity disclosures and growing patient interest, use of mastectomy has grown over the years, according to the study. 

One famous case of celebrity disclosure came in 2013 when Hollywood star Angelina Jolie revealed that she had undergone a preventive double mastectomy to reduce her risk of developing breast cancer.

The new 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. 

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," said lead study author Reshma Jagsi, Professor at Michigan Medicine, University of Michigan in the US. 

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," 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," she added.

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, Jagsi added.

With the growing use of mastectomy, fuelled 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, the study authors said.