Breast cancer is one of the most common forms of cancer in the US. According to breastcancer.org, 1 in 8 women in the US will develop breast cancer at some point in their lifetime.
If you or a loved one has been diagnosed with breast cancer, there could be help available for you. The Social Security Administration offers financial resources for men and women with breast cancer who are no longer to work due to their condition.
The Financial Costs of Breast Cancer
A diagnosis of breast cancer will almost always require surgery and/or radiation. Most breast cancer patients will also require chemotherapy. Without insurance, the costs of these treatments can be astronomical. Of the 12 drugs approved for cancer treatment by the FDA in 2012, 11 of them cost $100,000 or more for just one year of treatment. The 12th drug costs $70,000 per year.
This is just the cost of treatment. A study in Quebec examined how many days off work women diagnosed with breast cancer missed when compared with women who were cancer free.
The average woman took nearly 6 months off work on average the year after her breast cancer diagnosis. Women who received chemotherapy were typically gone for more than 9 months.
On top of this, one full year after being cancer free, 85% of breast cancer survivors were absent from work 4 weeks or more. Just 18% of the healthy women were absent from work 4 weeks or more. Ongoing doctor’s visits and care continued to keep women from work. The average absence from work did not normalize between the two groups until three years after the cancer was treated.
The study shows that breast cancer’s costs are astronomical, and many women are unable to work at all due to treatment. Social Security disability benefits are an option for women who are diagnosed with breast cancer and need help. Because of the prevalence of breast cancer in the US, the Social Security Administration (SSA) lists breast cancer as a disabling condition and a potentially qualifying disability.
Stages of Breast Cancer
Breast cancer can go through four stages, with stage four cancer disability representing the most serious stage of the disease. Breast cancer caught early enough is considered stage zero in some medical circles, but most oncologists refer to just four stages of breast cancer.
Stage one breast cancer is considered invasive, which means tumorous cells have broken away from the original source of cancer and started to attack healthy cells and tissue. The first stage of cancer can include cancer spreading into the fatty breast tissue, with a tumor no larger than an average size shelled peanut.
Stage two breast cancer develops when cancer has spread to other areas in both breasts and/or the tumors have grown in size. At this point in the development of breast cancer, tumors can grow as large as a mature walnut or even larger than the size of a lime. Stage two breast cancer can impact the lymph nodes, but that is not always the case.
Stage three breast cancer is considered an advanced stage, although cancerous cells have not yet spread to bones and/or organs. Cancer has spread into a maximum of nine lymph nodes that form a chain from the armpit to the collarbone. Tumors have spread in the chest and the skin surrounding the breasts.
When breast cancer reaches stage four, it has spread to bones, as well as the liver, brain, and lungs. The last stage of breast cancer is called metastatic, which means it has spread well beyond the area of the body where it was first detected. Because of the severity of stage four symptoms, a patient might automatically qualify for disability.
Average Time Off Work With Breast Cancer
It's not uncommon for women who have breast cancer to take time off work after they've been diagnosed. In fact, according to recent research, most women (almost 6 months on average) take a significant amount of time off work after receiving the diagnosis.
Medically Qualifying for Benefits with the Blue Book
Whenever the SSA receives an application for benefits, it evaluates the condition and symptoms based on their own guide. This guide, known as the Blue Book. The Blue Book lists hundreds of disabilities that could potentially qualify for benefits, along with the medical test results or symptoms that are necessary to be approved.
Breast cancer is listed along with other cancers in Section 13.00—Malignant Neoplastic Diseases.
For breast cancer to qualify, you must have doctor’s reports or test results that show one of the following:
- An advanced breast cancer that has extended to the chest, skin, or internal mammary nodes.
- A carcinoma (cancer started in the cells of the skin or tissue lining organs) that has spread above or below the collarbone, has spread to 10+ nearby nodes, or spread to distant regions of the chest.
- A carcinoma that returns after anticancer therapy.
- Small-cell (oat cell) carcinoma.
The SSA’s listing for breast cancer is very technical. You will need to speak with your doctor to see if your specific cancer has spread to the extent to qualify for disability benefits via the Blue Book. Typically, breast cancer must be stage three or above to qualify for disability benefits medically.
Compassionate Allowances and Breast Cancer
When a disability severe and an applicant clearly needs assistance, the SSA will expedite the application process. Instead of having to wait for 5+ months to be approved like the typical applicant, conditions that qualify for a Compassionate Allowance will be approved in as little as ten days.
Breast cancer that is advanced can usually qualify for a Compassionate Allowance if it meets one of the three following conditions:
- Your breast cancer has metastasized (spread to distant organs).
- Your breast cancer has returned despite undergoing chemotherapy or another cancer treatment.
- Your breast cancer is inoperable.
Applying for disability benefits successfully typically requires a wealth of medical history or paperwork, but if you can have one piece of medical evidence showing that you qualify for a Compassionate Allowance, you should be approved quickly.
Examples of qualifying medical records could include a surgeon’s testimony stating that your cancer is inoperable, or an oncologist’s record of your cancer returning despite you successfully undergoing a year of chemotherapy. You could also provide a biopsy report that shows that your cancer has spread to nearby organs, such as the lungs.
Qualifying Without Meeting a Medical Listing
If you’re lucky, your breast cancer will have been diagnosed at an earlier stage than III or IV. Although early stages of breast cancer are not listed in the Blue Book, you can still qualify for disability benefits.
To qualify for benefits without meeting a medical listing in the Blue Book, you will need to have doctors’ notes and hospital records that show that you are expected to be out of work for at least 12 months. Speak with your doctor about your treatment and whether or not you’ll be out of work for more than a year.
The most common way women can get approved for disability benefits without the Blue Book is through a physical Residual Functional Capacity (RFC) evaluation. This is a long form filled out by your doctor about your general health and wellbeing.
Keep in mind that if you do need to file for disability benefits via an RFC, your education level will be factored into your evaluation. If you went to college and could be qualified for sedentary work, the SSA might think that although your symptoms are severe, you could find some form of desk work to do and do not qualify.
A woman who has no education and worked her entire life as a construction worker or a stay-at-home mother would have a much higher chance of qualifying via an RFC than a woman who went to college and got her degree in finance or any other major that can be applied to many jobs.
How to Apply for Social Security Disability Benefits
Speak with your oncologist about whether or not you meet the SSA’s Blue Book listing and your chances of qualifying for disability benefits. The application process can take a long time, so you will not want to waste any time applying if you do not have a chance of being approved.
A quick way to get approved is to actually submit all of your medical records to the SSA. The SSA does have the ability to gather them itself, but submitting them will increase the speed of your approval. Some important tests to submit would include:
- Biopsy results of your tumor
- Oncologist’s notes of your progress
- Surgeon’s remarks
- A history of treatments you’ve received and how long you had them, such as chemotherapy, radiation, and surgeries.
Many women can apply for disability benefits online and will never need to stop by a local SSA office. If you are applying online, be sure to take your time and submit as much information as possible. Never leave any information blank on the form. If you make a mistake such as misspelling the name of the hospital you were treated at, the SSA may not be able to find your medical records and deny you. Silly technical errors are why an overwhelming amount of denied disability claims.
If your breast cancer worsens while you wait to be approved, be sure to contact the SSA immediately to report the change in your condition. If you are required to go through any new or additional treatments, such as a surgery to remove a tumor, you should report this as well.
If you are approved for disability benefits, your spouse and children could also qualify for benefits. To learn more about the different forms about disability benefits, visit our pages on Social Security Disability Insurance and Supplemental Security Income.
You have a lot to gain from a successful Social Security disability claim. A successful claim wouldn’t just mean consistent financial support for your ailment—it would also grant you the kind of stability that you may have been missing out on for years now. Unfortunately, winning a claim isn’t a cakewalk, which is why you should consider consulting a Social Security disability attorney or disability advocate. Your attorney will use his or her knowledge and experience to fight on your behalf and help you get the benefits you need—and you don’t even need to pay your lawyer unless you win. A successful Social Security claim could be life-changing, so don’t wait to get an evaluation and talk to a Social Security disability attorney as soon as possible.