Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cancer, Breast


Related Terms

  • Breast Cancer
  • Breast Carcinoma
  • Breast Neoplasm

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • General Surgeon
  • Oncologist
  • Physical Therapist
  • Plastic Surgeon
  • Radiology Oncologist

Comorbid Conditions

Factors Influencing Duration

The length of disability varies significantly according to the type and stage of cancer, treatment(s), and extent of the cancer. More extensive cancer and more aggressive treatment require a longer period of disability. For individuals with lumpectomy or segmental or partial mastectomy, duration depends on the amount of tissue removed, size of incision, and type of anesthesia (local or general). For individuals with radical mastectomy, duration depends on whether the dominant or nondominant arm is affected and the extent of surgery. Older women and those in poor health usually experience a longer period of recovery. A woman's nutritional status also plays a part in the length of disability. Women with metastatic cancer that has spread to bone, brain, lungs, or liver are permanently disabled.

Medical Codes

ICD-9-CM:
174.0 - Malignant Neoplasm of Female Breast; Nipple and Areola
174.1 - Malignant Neoplasm of Female Breast; Central Portion
174.2 - Malignant Neoplasm of Female Breast; Upper-inner Quadrant
174.3 - Malignant Neoplasm of Female Breast; Lower-inner Quadrant
174.4 - Malignant Neoplasm of Female Breast; Upper-outer Quadrant
174.5 - Malignant Neoplasm of Female Breast; Lower-outer Quadrant
174.6 - Malignant Neoplasm of Female Breast; Axillary Tail
174.8 - Malignant Neoplasm of Female Breast; Other Specified Sites of Female Breast, Ectopic Sites, Inner breast, Lower Breast, Midline of Breast, Outer Breast, Upper Breast
174.9 - Malignant Neoplasm of Female Breast, Unspecified
175.0 - Malignant Neoplasm of Male Breast; Nipple and Areola
175.9 - Malignant Neoplasm of Male Breast; Other and Unspecified Sites of Male Breast; Ectopic Breast Tissue, Male
198.81 - Secondary Malignant Neoplasm of Other Specified Sites; Other Specified Sites, Breast
233.0 - Carcinoma in Situ of the Breast

Overview

Breast cancer refers to the presence of abnormal (malignant) cells or a malignant lesion (neoplasm or tumor) in breast tissue. It is the most common cancer in women after skin cancer but occurs only rarely in men. Most breast cancers develop in the glandular tissue of the breast (adenocarcinoma), including the ducts that carry milk from the lobes of the breast to the nipple (ductal carcinoma), and the lobes themselves (lobular carcinoma). Malignant cells divide more rapidly than normal healthy cells (cellular proliferation) and may spread throughout breast tissue and into surrounding tissue or lymph glands (invasive cancer). Malignant cells that enter the lymphatic system through the lymph nodes under the arm can travel to distant organs (metastasize) such as reproductive organs, the brain, liver, bones, or lungs (metastatic cancer).

It isn't known precisely why normal breast cells become cancerous, although families that have genetic defects or mutations in certain breast-cancer-related genes have an increased likelihood of developing breast cancer. Age, family history of cancer, radiation exposure, and increased exposure to estrogen (including use of birth control pills and hormone replacement therapy) are among factors that may also influence breast cancer development. Screening mammograms, a series of x-ray images of breast tissue, are considered to be the best diagnostic imaging procedure for detecting cancer early.

When a breast lesion or lump is discovered, a biopsy of breast tissue will be performed to examine the cells and surrounding tissue and determine if the cells are malignant (cancerous) or benign (noncancerous). Terms that describe types of cancer are applied based on the appearance of the tumor cells under a microscope (histology). Additional testing may indicate if the cells have migrated within the breast, outside the breast, or to other areas of the body. Breast cancer kills by spreading to other vital organs (brain, lung, liver), and damaging the function of those organs.

The most common type of noninvasive breast cancer or "pre-cancer" is ductal carcinoma in situ (DCIS), accounting for 20% of new breast cancer diagnoses ("Detailed Guide"). Mammography can detect DCIS early, and nearly all individuals with this type of breast cancer can be treated effectively. Lobular carcinoma in situ (LCIS) can also be detected early and does not usually become invasive (grow locally into breast tissue) itself, but can be predictive of other, more invasive breast cancers, necessitating more frequent clinical examination and mammography.

The most common type of invasive breast cancer is infiltrating ductal carcinoma (IDC), accounting for up to 80% of all invasive breast cancers. Infiltrating lobular cancer (ILC) accounts for 10% of invasive breast cancers ("Detailed Guide"). Like IDC, it can also metastasize to other organs, but ILC is quite difficult to detect by mammography.

Many additional tissue types of breast cancer occur rarely. Those with a somewhat better prognosis include adenoid cystic (or adenocystic) carcinoma, low grade adenosquamous carcinoma, medullary carcinoma, mucinous (or colloid) carcinoma, papillary carcinoma, and tubular carcinoma. Sub-types with somewhat worse prognosis include metaplastic carcinoma (including spindle cell and squamous), micropapillary carcinoma, and mixed carcinoma. Additional types include inflammatory carcinoma, Paget disease of the nipple, phyllodes tumor, and angiosarcoma.

Other changes may be found in the breast that are benign—please see Fibrocystic Breast Disease for more detail.

Incidence and Prevalence: Over 2 million women in the US have, or have had, breast cancer. About 1,384,000 new cases were diagnosed worldwide in 2008 ("UpToDate"). (There are about 2,000 cases diagnosed each year in men.) The number of new cases per year has decreased since 2001, when 276,000 new cases were diagnosed, of which 217,000 were invasive cancer and 59,000 were in situ (Abeloff). After lung cancer, breast cancer is the second leading cause of cancer death in American women. However, worldwide, breast cancer is the leading cause of death among women, followed by lung cancer. Mortality rates have decreased in recent years (Abeloff), due in part to early detection, advances in treatment, and increasing awareness of the influence of estrogen exposure on development of breast cancer (much less frequent post-menopausal hormone replacement therapy). Thirty-five years ago, about 75% of women with breast cancer survived their disease at least 5 years; now, about 90% of women with breast cancer survive the disease at least 5 years ("Cancer Advances").

Source: Medical Disability Advisor



Causation and Known Risk Factors

The risk of breast cancer increases with age. The disease is less commonly diagnosed in women under 40, with 13% of all breast cancers diagnosed in women younger than 45 years of age ("Detailed Guide"). The lifetime risk is about 1 in 8; the age-specific risk is 1 in 250 by age 40 and 1 in 35 at age 60 and older (Abeloff). Other risk factors include previous breast cancer, one first-line relative (mother, daughter, or sister) or at least 2 second-line relatives (cousin or aunt) with breast cancer, and breast tissue with previous precancerous changes. Relatives with ovarian cancer also increase the risk for breast cancer. A woman's genetic predisposition to breast cancer can sometimes be determined by testing for defects or mutations in genes known to be associated with breast cancer (BRCA1, BRCA2, ATM, TP53, PTEN, CDH1, STK11, and CHEK2) ("Detailed Guide"). The lifetime risk for women with mutations in some of these genes is 10 times greater than that of women with no defects in these genes ("Cancer Advances"). Of women with breast cancer, 20% to 30% have a family member with the disease ("Detailed Guide").

Increased exposure to estrogen is another risk factor for breast cancer. Women who had early onset of menstruation (before age 12) or late menopause (after age 55), whose first pregnancy was after age 30, or who have used hormone replacement therapy or birth control pills over a long period of time, have been exposed to increased levels of estrogen. Women whose breast tissue includes a higher proportion of lobular or ductal tissue (“dense breasts”) in which breast cancer typically arises, and women whose breasts have been exposed to radiation, such as in the treatment of Hodgkin's disease, are also at increased risk. Other risk factors include alcohol use, cigarette smoking, sedentary lifestyle, and obesity. White women are at slightly greater risk for developing breast cancer than black, Hispanic, or Asian women, but black women have been found to be more likely to die of breast cancer, because the cancer is more advanced when diagnosed ("Breast Cancer").

Although research studies have identified these risk factors, many women with breast cancer have none of them. Likewise, most women with these risk factors never develop breast cancer.

Source: Medical Disability Advisor



Diagnosis

History: Breast cancer patients present with 1 of 3 histories. Some have asymptomatic and usually non-palpable tumors detected by screening mammography. Some have local changes in the breast that cause the woman to seek care (lump, skin changes, nipple changes, discharge at the nipple). Some present when metastatic disease becomes evident (such as with an enlarged lymph node or symptomatic brain metastatic tumor).

Signs of breast cancer are not always evident or identifiable during self-examination, or physician examination.

Physical exam: Physical examination begins with inspection of the breasts in both the upright and supine positions. The breasts are assessed for symmetry, nipple inversion, skin dimpling, and edema. During a breast examination, the physician uses his or her fingers to feel (palpate) and press on the breast and surrounding tissue. As in breast self-examination, signs of breast cancer may include a lump or thickening, change in breast shape or size, discharge from or change in a nipple, and / or a change in skin texture, including inflammation. The supraclavicular, infraclavicular, and axillary lymph nodes are also assessed.

Tests: Genetic testing may be done to identify gene defects and risk in individuals with a family history of breast cancer or other types of cancer. Routine genetic testing is not recommended.

Screening mammography is a series of x-rays that screen for breast cancer, sometimes revealing tumors that are too small to be felt. Mammography is able to provide additional information about lumps, thickening, or other changes that may have been discovered during clinical breast examination. Sometimes mammography can also indicate an area of concern when no actual problem exists (false-positive result). Breast ultrasound is able to determine whether lumps are fluid-filled sacs (cysts) that are typically benign, or are solid masses that are more typically malignant. For women with moderate to high lifetime risk of breast cancer, the American Cancer Society currently recommends an annual MRI in addition to the annual mammogram (Detailed Guide).

Newer imaging technologies available to detect breast cancer in high-risk individuals, include full-field digital mammography, in which the computer image of the mammogram may be manipulated to improve visualization; computer-aided detection and diagnosis (CAD), in which a computer assists the radiologist in examining mammography images; and scintimammography, in which a radioactive tracer that attaches to breast cancer cells is injected intravenously to allow differentiation between normal cells and malignant cells.

MRI, CT scans, PET, and bone scans may also help in diagnosing secondary cancers that may have metastasized from breast tissue to reproductive organs, bones, liver, or lungs.

Neither mammography nor ultrasound tests can confirm or rule out a diagnosis of cancer. To confirm a diagnosis, a sample of suspicious tissue must be removed (biopsy), stained, and then examined under a microscope to determine whether malignant cells are present. The size and location of the tumor determine whether the biopsy will be a fine-needle aspiration biopsy, core needle biopsy, stereotactic biopsy (core needle biopsy during mammography), or surgical biopsy. If malignant cells are found, a biopsy will also be performed on tissue obtained from lymph nodes under the arms. Specific hormone tests (estrogen receptor assay and progesterone receptor assay) may be performed to determine whether cancer growth is dependent on estrogen or progesterone and if it will respond to hormone-suppression treatment.

A Herceptin test may also be performed on a breast tissue sample to determine if the cancer cells manufacture too much of a protein called HER2, which may guide future treatment.

Once detected, breast cancer is staged by the “T, N, M” system, in which “T” stands for tumor, “N” stands for (lymph) nodes, and “M” stands for metastases.
- the letter T followed by a number from 0 to 4 describes the tumor's size and spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and / or wider spread to tissues near the breast.
- the letter N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are affected.
- the letter M followed by a 0 or 1 indicates whether the cancer has spread to distant organs—for example, the lungs or bones.

Source: Medical Disability Advisor



Treatment

The size and location of the cancer, its stage, and the results of laboratory tests such as hormone receptor and Herceptin tests determine the course of treatment. The physician may also consider the woman's age, health status, and breast size, as well as her menopausal status. Most breast cancer is treated both locally at the site of the cancer and systemically, involving the whole body.

In general, the smaller and more contained the cancer, the more localized the treatment (e.g., lumpectomy and focused radiation). Conversely, the larger the cancer and the more it has invaded nearby tissue or spread throughout the body, the more aggressive and systemic the treatment (e.g., mastectomy and chemotherapy).

Surgery is the most common breast cancer treatment and can take several different forms. A lumpectomy is the removal of only the cancerous lump and its surrounding tissue, sparing most of the breast tissue. Surgeries known as segmental or partial mastectomies spare as much healthy breast tissue as possible but remove the tumor and surrounding tissue. More extensive surgeries involve removal of the entire breast (modified radical mastectomy). A radical mastectomy, which is rarely performed today, removes the entire breast, all or most of the nearby lymph nodes, usually some of the skin over the breast, and some chest muscles. A woman can choose to have surgery to rebuild her breast (breast reconstruction with implants or tissue flaps) at the time of the initial surgery or at a later date.

Studies indicate that survival rates improve with the use of chemotherapy and / or radiation following surgery. Chemotherapy is the use of a drug or a combination of drugs to destroy cancer cells. The drugs are taken either orally or intravenously according to a predetermined schedule. The patient receives chemotherapy for a limited amount of time, followed by a break for a limited amount of time. Treatment cycles repeat as often as prescribed, and the individual's response to treatment is monitored. Radiation therapy irradiates cancer cells to destroy them. The radiation may come from a machine (external radiation) or from radioactive material surgically implanted inside the individual (brachytherapy).

Hormone-suppression or hormone-blocking therapy robs estrogen-dependent or progesterone-dependent cancer cells of the estrogen or progesterone they need in order to grow. Hormone suppression chemically alters the hormones to make them unusable by the malignant cells, thereby suppressing their continued growth. Another type of drug therapy employs selective estrogen receptor modulators (SERMs) that prevent breast tissue cells from using estrogen, which in turn slows or stops the growth of cancer cells. Preventive use of SERMs also reduces the frequency of breast cancer in women at high risk. Used following surgery, SERMs reduce the chances of the cancer returning or a new cancer forming in the other breast. Aromatase inhibitors are another class of drugs that block the conversion of a hormone-related substance into estrogen to stop estrogen production in any cells except ovarian cells; these drugs have only been shown to be effective in postmenopausal women. Eliminating the natural source of hormones, such as surgery to remove the ovaries (oophorectomy), is another option for treating or preventing estrogen-dependent cancer.

Chemotherapy, radiation, and hormone-suppression therapy can also be recommended as adjuvant therapies before and / or after surgery. For example, radiation therapy may be used before surgery to shrink a tumor in order to facilitate its removal. Radiation can also be used after surgery to help kill any cancer cells that surgery missed. Radiation therapy can be combined with chemotherapy or hormone-suppression therapy.

Monoclonal antibody therapy is a newer biological therapy that can be helpful in treating the one-third of breast cancers that overproduce growth-promoting protein. Use of monoclonal antibodies to attack the HER2 protein may inhibit the growth of breast cancer cells and stimulate the immune system to produce anticancer antibodies. This technique may be also be used in conjunction with chemotherapy and / or hormone-suppression therapy, especially in women with advanced metastatic breast cancer. Drugs in this class include trastuzumab (or Herceptin), pertuzumab (or Perjeta), and lapatinib (Tykerb). Everolimus (Affinitor) blocks mTOR, an intra-cellular protein that regulates cell growth.

Another biological therapy, bevacizumab, targets new blood vessels required by cancer cells for survival; the drug stops the growth of blood vessels and destroys the cancer cells. Many new drugs that target cancerous breast tissue are in clinical trials.

Bisphosphonates are used to prevent bone weakening (pathologic fractures) adjacent to breast cancer that has spread to bone, and to prevent osteoporosis as a side effect of aromatase inhibitors used in breast cancer treatment.

Source: Medical Disability Advisor



Prognosis

The outcome depends primarily on the type of cancer, and its stage at discovery, and its response to treatment. A woman's age, menopausal status, and overall health also contribute to the outcome. Tumors in younger women are in general more aggressive.

The best outcome occurs with small tumors that have not yet invaded nearby tissue or spread to any lymph nodes. Women with stage I breast cancer have a 5-year survival rate of 84%; the 5-year survival rate for those with stage IV is 18% ("Prognosis").

Systemic adjuvant therapy significantly increases the odds of a successful outcome.

Source: Medical Disability Advisor



Rehabilitation

Physical therapy may be needed after mastectomy to reduce postoperative swelling, stretch and strengthen arm and shoulder muscles, and promote normal posture.

An important facet of physical therapy for individuals after a mastectomy is lymphedema education. Lymphedema is a swelling in the arm on the side of the mastectomy that is caused by an interruption in the flow of lymph. Individuals learn to recognize the early symptoms of lymphedema, such as increased heaviness in the arm, tightness of the skin, stiffness in the hand and fingers, and altered sensation in the arm.

Individuals with lymphedema as a result of a mastectomy or radiation therapy may require additional physical or occupational therapy to reduce swelling. Individuals also learn to avoid sources of overload on the lymphatic system, such as prolonged arm activities and heat (including heating pads).

Individuals may also benefit from psychological counseling or a support group for cancer survivors. Postmastectomy individuals may require help as they adjust their body image. Men who are afflicted by breast cancer may also have special support needs.

Source: Medical Disability Advisor



Complications

Metastatic cancer can cause a variety of symptoms, depending on where secondary cancer has developed; for example, if cancer has spread to the bone, it can be very painful.

The psychological impact of breast cancer cannot be ignored. Most women report feeling a loss of self-esteem, decrease or total loss of sexuality, fears about dying, general feelings of anxiety, sadness, anger, irritability, difficulty with concentration, and changes in sleep and eating patterns. Depression is common.

Hormone-suppression treatment, radiation, and chemotherapy are known to cause other complications.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Reassignment of job duties may be needed if work requires upper body motion and strength. Following a mastectomy, muscle strength in a woman's arm and shoulder may diminish, and range of motion may also be reduced. These losses may be temporary or permanent.

Lymphedema in an arm may interfere with job duties requiring use of that arm. Because an injured arm is more at risk for lymphedema, protection of the affected arm while on the job may be prudent. Use of a compression garment for the arm may be necessary.

Individuals undergoing radiation therapy, chemotherapy, or hormone-suppression therapy may feel fatigued. While undergoing chemotherapy, accommodations may be needed for time off or for lenient breaks in order to handle side effects such as nausea and vomiting. Damage done to the skin by radiation may require that loose clothing be worn until the skin heals.

Risk: According to "Work Ability and Return to Work," "Risk in cancer survivors may be due to chemotherapy. If there is physical exam or electrodiagnostic test evidence of chemotherapy associated peripheral neuropathy, balance may be impaired, and restrictions that would prevent climbing to heights may be indicated. If corticosteroids or chemotherapy have resulted in osteoporosis, restrictions to prevent pathologic fracture may be indicated (limited climbing to heights, limited heavy lifting, etc). As long as immune system suppression exists after treatment, patients should be restricted from working with sick animals or humans and from fungal exposure (eg, gardening)" (406).

Capacity: According to "Work Ability and Return to Work," "Patients may have residual myopathy after chemotherapy, and functional testing may be indicated to quantitate residual functional capacity. Some chemotherapy agents have cardiac and pulmonary toxicity, and treadmill testing of exercise ability may be helpful to establish current ability. Similarly, some cancer surgery (eg, pneumonectomy) will decrease cardiopulmonary function (capacity for work or exercise). Similarly, anemia may be significant during and after chemotherapy, and treadmill exercise testing can give both the physician and the patient an idea about exercise or work capacity" (406-407).

Tolerance: The reader is strongly encouraged to read "Work Ability and Return to Work," pages 399-410, as tolerance issues tend to predominate, especially after normal expected surgical healing. Chemotherapy can have effects on functioning which limits tolerance for the work environment. Ideally, reduced work hours may accommodate that limitation while creating a permissive environment of eventual return to work. According to "Work Ability and Return to Work," "Patients undergoing chemotherapy and / or radiation therapy typically have symptoms like nausea, diarrhea, and fatigue that are clearly due to their treatment, and in Western society these symptoms are traditionally judged to be severe enough to justify certification of work absence during the active phase of cancer treatment. Despite these symptoms, many of the self-employed and uninsured return to work" (407). For additional information, please refer to "Work Ability and Return to Work," pages 402-403, Table 2-21.

Accommodations: Reducing the physical demands of work tasks and the hours of work during active radiation and / or chemotherapy should frequently result in successful return to modified duty.

Source: Medical Disability Advisor



Maximum Medical Improvement

Breast Cancer patients undergoing chemotherapy are not at MMI until 84 days post-chemo. Patients who require mastectomy would be at MMI at 84 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was diagnosis of breast cancer confirmed?
  • Does individual have an underlying condition such as pregnancy, obesity, advanced age, etc. that may affect recovery?

Regarding treatment:

  • What treatment has been received to date, and what treatment is planned in the near future?
  • Although unavoidable, are treatment side effects present, and if present are they being effectively managed?
  • Are appropriate efforts being made to prevent or manage lymphedema?
  • Is referral to an EAP or psychologist/psychiatrist indicated based on symptoms of anxiety or depression?

Regarding prognosis:

  • Has individual had a mastectomy, was breast reconstruction an option?
  • Was reconstruction surgery performed? If not, what are the barriers to having that surgery?
  • How is individual's nutritional status? Is individual getting enough rest?
  • Because surgery and chemotherapy increase the risk of infection, is individual unnecessarily exposed to infection at home or on the job?
  • Is the psychological impact of this disease being addressed? Was referral made for counseling?

Source: Medical Disability Advisor



References

Cited

"Breast Cancer." MayoClinic.com. 29 Nov. 2011. Mayo Foundation for Medical Education and Research. 11 Mar. 2013 <http://www.mayoclinic.com/health/breastcancer/DS00328>.

"Cancer Advances in Focus: Breast Cancer." National Cancer Institute. 23 Sep. 2010. New Media Systems, LLC. 11 Mar. 2013 <http://www.cancer.gov/cancertopics/cancer-advances-in-focus/breast.>>.

"Detailed Guide: Breast Cancer." American Cancer Society. 27 Feb. 2013 <http://www.cancer.org/cancer/breastcancer/detailedguide/index>.

"Prognosis." BreastCancerSource. 27 Feb. 2013 <http://hcp.breastcancersource.com/article/500287.aspx>.

Abeloff, Martin D., et al., eds. "Breast Cancer." In Clinical Oncology. 3rd ed. Philadelphia: Churchill Livingstone, Inc., 2004.

Esserman, Laura, et al. "Clinical features, diagnosis, and staging of newly diagnosed breast cancer." Up To Date (2013): NA. UpToDate. 28 Jan. 2013. Walters Kluwer. 11 Mar. 2013 <http://www.uptodate.com/contents/clinical-features-diagnosis-and-staging-of-newly-diagnosed-breast-cancer?source=search_result&search=breast+cancer&selectedTitle=25~150>.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Source: Medical Disability Advisor






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