Worker Productivity | Breast Cancer Evaluation Measures

Worker productivity measures for breast cancer screening1-10

Healthier employees are less likely to call in sick. Companies can sometimes assess sick day use to determine whether health programs are increasing worker productivity.  

There is some evidence that women who receive false positive results (when a mammogram is judged to have positive findings of abnormalities when the true result is negative) for screening mammograms have an increased risk of anxiety and depression.4 This experience may affect productivity, and appropriate psychological support for these women should be available.


  • Determine the average number of sick days per employee over the previous 12 months related to breast cancer screening, diagnosis, or treatment 
    • This measure may be less useful if there has been a large increase or decrease in numbers of employees over the past 12 months
  • Determine the costs for worker absenteeism including costs of replacement workers, costs in training replacement workers, and loss and delay in productivity
  • Additional validated surveys have been developed to provide employers with information about the indirect costs of untreated or undertreated employee health issues such as breast cancer. Employers who use these health and productivity surveys on an ongoing basis can begin to evaluate the return on investment (ROI) of offering breast cancer screening programs on employee absence or productivity. These surveys may be proprietary and may require a modest fee to use. Two examples are provided below: 
    • Health and Work Performance Questionnaire (HPQ) is a short, easy to administer self-report survey designed to estimate workplace indirect costs (absenteeism, reduced productivity, and injury due to accidents) of employee health problems developed by the World Health Organization (WHO) and the Harvard Medical School
    • The Work Limitations Questionnaire (WLQ) developed by the Health Institute at Tufts Medical Center is an easy to use questionnaire that addresses general work limitations which can be built into other health assessment tools such as a health risk appraisal or employee health survey


  • Re-assess the average number of sick days per employee at the first follow-up evaluation 
    • If employee education programs are successful, these measures may increase in the short term as screening and detection rates increase
  • Periodic repeats of other baseline measures


  • Assess changes in the average number of sick days per employee in repeated follow-up evaluations
  • Assess changes in costs from baseline

1.  Jatoi I, Zhu K, Shah M, Lawrence W. Psychological distress in U.S. women who have experienced false-positive mammograms. Breast Cancer Res Treat. 2006 Nov;100(2):191-200. Epub 2006 Jun 14.

2.  Centers for Disease Control and Prevention with the Prudential Center for Health Care Research. The manual of intervention strategies to increase mammography rates. 1997. Available from: [PDF – 4.4MB]

3.  Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, editors. A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006.

4.  Centers for Disease Control and Prevention. Framework for program evaluation in public health. Morbidity and Mortality Weekly Report 1999;48(No. RR-11): 1-40.

5.  Goetzel RZ, Ozminkowski RJ. Program evaluation. In: O’Donnell MP, editor. Health promotion in the workplace, 3rd edition. Albany, NY: Delmar Thomson Learning; 2002. p 116-165.

6.  Matson Koffman DM, Lanza A, Campbell KP. A Purchaser’s Guide to Clinical Preventive Services: A tool to improve health care coverage for prevention. Preventing Chronic Disease, April 2008; 5(2).

7.  Kessler RC, Barber C, Beck A, Berglund P, Cleary PD, McKenas D, Pronk N, Simon G, Stang P, Ustun TB, Wang P. The World Health Organization Health and Work Performance Questionnaire (HPQ). J Occup Environ Med. 2003 Feb;45(2):156-174.

8.  Kessler RC, Ames M, Hymel PA, Loeppke R, McKenas DK, Richling DE, Stang PE, Ustun TB. Using the World Health Organization Health and Work Performance Questionnaire (HPQ) to evaluate the indirect workplace costs of illness. J Occup Environ Med. 2004 Jun;46(6 Suppl):S23-37.

9.  Wang PS, Beck A, Berglund P, Leutzinger JA, Pronk N, Richling D, Schenk TW, Simon G, Stang P, Ustun TB, Kessler RC. Chronic medical conditions and work performance in the health and work performance questionnaire calibration surveys. J Occup Environ Med. 2003 Dec;45(12):1303-1311.

10.  Lerner D, Amick BC 3rd, Rogers WH, Malspeis S, Bungay K, Cynn D. The Work Limitations Questionnaire. Med Care. 2001 Jan;39(1):72-85.