A new survey finds that women who undergo double mastectomy for early stage breast cancer are nearly 8 times more likely to miss work. The findings reopen discussion about the benefits and risks of such radical procedures. Furthermore, it reinforces the need for individualized treatment approaches because no one course of action will be suited for every patient.
For the study, researchers surveyed over 1,000 women who were diagnosed and treated for early stage breast cancer. The team collected details about treatment approaches, employment, and employment support, among other factors.
They found that 19 percent of women opted for bilateral mastectomy, the removal of both breasts, followed by surgical reconstruction. Compared to women who underwent lumpectomy and radiation therapy, these women were 7.8 times more likely to miss at least one month from work, or stop working altogether.
"It really stood out, especially because bilateral mastectomy has not been demonstrated to improve survival, and clearly has a negative impact on employment," said Dr. Reshma Jagsi, professor and deputy chair of radiation oncology at Michigan Medicine, and the study’s lead author.
"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,” Dr. Jagsi explained.
"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."
The authors hope the findings encourage women and their doctors to talk more openly about all available options, and the benefits and risks associated with each. The key may be empowering patients with complete and accurate information so that they will be fully informed when enacting autonomy of their health options.
"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,'" said 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."
"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," said 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."
The long-term consequences of bilateral mastectomy, in terms of employment and quality of life, are still to be investigated.
Additional sources: University of Michigan