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Employment Changes following Breast Cancer Diagnosis: The Effects of Race and Place


Spencer, Jennifer C.; Rotter, Jason S.; Eberth, Jan M.; Zahnd, Whitney E.; Vanderpool, Robin C.; Ko, Linda K.; Davis, Melinda M.; Troester, Melissa A.; Olshan, Andrew F.; & Wheeler, Stephanie B. (2020). Employment Changes following Breast Cancer Diagnosis: The Effects of Race and Place. Journal of the National Cancer Institute, 112(6), 647-650. PMCID: PMC7301070


The financial implications of breast cancer diagnosis may be greater among rural and black women. Women with incident breast cancer were recruited as part of the Carolina Breast Cancer Study. We compared unadjusted and adjusted prevalence of cancer-related job or income loss, and a composite measure of either outcome, by rural residence and stratified by race. We included 2435 women: 11.7% were rural; 48.5% were black; and 38.0% reported employment changes after diagnosis. Rural women more often reported employment effects, including reduced household income (43.6% vs 35.4%, two-sided χ2 test P = .04). Rural white, rural black, and urban black women each more often reported income reduction (statistically significant vs. urban white women), although these groups did not meaningfully differ from each other. In multivariable regression, rural differences were mediated by socioeconomic factors, but racial differences remained. Programs and policies to reduce financial toxicity in vulnerable patients should address indirect costs of cancer, including lost wages and employment.


Reference Type

Journal Article

Article Type


Year Published


Journal Title

Journal of the National Cancer Institute


Spencer, Jennifer C.
Rotter, Jason S.
Eberth, Jan M.
Zahnd, Whitney E.
Vanderpool, Robin C.
Ko, Linda K.
Davis, Melinda M.
Troester, Melissa A.
Olshan, Andrew F.
Wheeler, Stephanie B.



Data Set/Study

Carolina Breast Cancer Study (CBCS)


United States of America