Journal of the National Cancer Institute · 2026
Explaining educational differences in return to work after early breast cancer: a mediation analysis.
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Ruiz de Azua Garazi, Licaj Idlir, Ntobeng Koketso, Havas Julie, Di Meglio Antonio, Vaz-Luis Ines, Martin Anne-Laure, Jouffroy-Zeller Claire, Lerebours Florence, Rigal Olivier, Fournier Marion, Mouret-Reynier Marie-Ange, Campone Mario, Tarpin Carole, Guillermet Sophie, Giacchetti Sylvie, Petit Thierry, Dalenc Florence, Dumas Agnès, Menvielle Gwenn
Аннотация
BACKGROUND: The mechanisms behind the effect of education on the return to work (RTW) of survivors of breast cancer (BCS) are unknown.
METHODS: We used data from 2461 BCS from the prospective cohort CANTO. Using inverse odds weights we studied the mediating effect of pre-existing comorbidities, clinical factors, post-treatment health related quality of life, working conditions and household composition in the association between education and non-RTW. We used education in three categories. All models were adjusted for age at diagnosis.
RESULTS: Non-RTW increased at lower levels of education. Compared to high educated women, women with <high school education were more likely not to return to work (RR = 1.43, 95% CI 1.28-1.61). After accounting for all mediators, the direct effect of education on RTW remained elevated but was not statistically significant (RR = 1.18, 0.96-1.46). The association between <high school education and non-RTW was mediated by pre-existing comorbidities (RR = 1.06, 1.00-1.13), post-treatment health-related quality of life (RR = 1.09, 1.01-1.18) and working conditions (RR = 1.19, 1.09-1.29). Differences were observed by age group, with larger inequalities among younger women. Among women aged ≥50, education differences in non-return to work were totally accounted for by all mediators (RR = 0.99, 0.75-1.29) whereas they remained elevated among women aged below 50 (RR = 1.30, 0.99-1.72).
CONCLUSIONS: Individuals with lower education are less likely to return to work. Poorer working conditions account for a large part of this association.
CLINICAL TRIAL: Registration: NCT01993498.
METHODS: We used data from 2461 BCS from the prospective cohort CANTO. Using inverse odds weights we studied the mediating effect of pre-existing comorbidities, clinical factors, post-treatment health related quality of life, working conditions and household composition in the association between education and non-RTW. We used education in three categories. All models were adjusted for age at diagnosis.
RESULTS: Non-RTW increased at lower levels of education. Compared to high educated women, women with <high school education were more likely not to return to work (RR = 1.43, 95% CI 1.28-1.61). After accounting for all mediators, the direct effect of education on RTW remained elevated but was not statistically significant (RR = 1.18, 0.96-1.46). The association between <high school education and non-RTW was mediated by pre-existing comorbidities (RR = 1.06, 1.00-1.13), post-treatment health-related quality of life (RR = 1.09, 1.01-1.18) and working conditions (RR = 1.19, 1.09-1.29). Differences were observed by age group, with larger inequalities among younger women. Among women aged ≥50, education differences in non-return to work were totally accounted for by all mediators (RR = 0.99, 0.75-1.29) whereas they remained elevated among women aged below 50 (RR = 1.30, 0.99-1.72).
CONCLUSIONS: Individuals with lower education are less likely to return to work. Poorer working conditions account for a large part of this association.
CLINICAL TRIAL: Registration: NCT01993498.