Background:
Breast cancer and its treatment may contribute to an increased risk of unemployment, influenced by both disease-related factors and socioeconomic determinant. Few longitudinal studies have examined employment outcomes among women diagnosed with cancer. This retrospective study investigated long-term employment among breast cancer survivors (BCS) and assessed disease specific and socioeconomic factors associated with employment.

Design and methods:
Registry-based data included working age BCS in Norway 2004–2008 alive at 6 years follow-up (N = 3560). The employment status on each BCS was compared to two matched non-cancer controls (N = 7081) by means of logistic regression analyses with marginal effects. Separate analyses by employment status at the time of diagnosis were conducted.

Results:
Among BCS employed at diagnosis, 73.7%, 71.5% and 71.8% of BCS were in employment at 1, 2 and 6 years after diagnosis, respectively. BCS employed at diagnosis had significantly lower probability of being employed at all follow-up time points, compared to controls. BCS outside employment at the time of diagnosis experienced lower probability of employment compared to controls. BCS with secondary or higher education had higher probability of employment compared to BCS with basic education, and BCS living in families with children were more likely to enter employment during follow-up compared to BCS without children.

Conclusions:
BCS employed at diagnosis had a subsequent risk of unemployment, and BCS not employed at diagnosis had lower probability of entering employment. Additional risk factors are high age, low education, and being single without children.

Significance for public health:
The risk of unemployment after a breast cancer diagnosis was increased. Job loss is costly economically and socially, both for individuals and for society. Early focus on employment particularly among employees with low education and with little family support may alleviate this problem.

This report has been prepared with funding from the Nordic Council of Ministers by experts at HEUNI, Fafo and Lund university.

The report is a response to a call by the Nordic Work Environment Committee in early 2024 seeking research on the relationship between labour market crime and work environment risks, with the aim of generating more knowledge and practical recommendations and solutions.

The intention of the research is to produce practical knowledge for work environment experts and regulatory authorities to combat labour market crime and contribute to preventing accidents and work-related ill health resulting from labour market crime.