{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:56:35Z","timestamp":1790740595993,"version":"4.1.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The mechanisms behind the effect of education on the return to work (RTW) of survivors of breast cancer (BCS) are unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Non-RTW increased at lower levels of education. Compared to high educated women, women with &amp;lt;high school education were more likely not to return to work (RR\u2009=\u20091.43, 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\u2009=\u20091.18, 0.96-1.46). The association between &amp;lt;high school education and non-RTW was mediated by pre-existing comorbidities (RR\u2009=\u20091.06, 1.00-1.13), post-treatment health-related quality of life (RR\u2009=\u20091.09, 1.01-1.18) and working conditions (RR\u2009=\u20091.19, 1.09-1.29). Differences were observed by age group, with larger inequalities among younger women. Among women aged \u226550, education differences in non-return to work were totally accounted for by all mediators (RR\u2009=\u20090.99, 0.75-1.29) whereas they remained elevated among women aged below 50 (RR\u2009=\u20091.30, 0.99-1.72).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Individuals with lower education are less likely to return to work. Poorer working conditions account for a large part of this association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial<\/jats:title>\n                    <jats:p>Registration: NCT 01993498<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jnci\/djag350","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T11:25:39Z","timestamp":1790594739000},"source":"Crossref","is-referenced-by-count":0,"title":["Explaining educational differences in return to work after early breast cancer: a mediation analysis"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7784-7571","authenticated-orcid":false,"given":"Garazi","family":"Ruiz de Azua","sequence":"first","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP , F-94805, Villejuif,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idlir","family":"Licaj","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP , F-94805, Villejuif,","place":["France"]},{"name":"UiT The Arctic University of Norway Department of Community Medicine, Faculty of Health Sciences, , Troms\u00f8,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koketso","family":"Ntobeng","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP , F-94805, Villejuif,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Havas","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP , F-94805, Villejuif,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Di Meglio","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP , F-94805, Villejuif,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Vaz-Luis","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP , F-94805, Villejuif,","place":["France"]},{"name":"Interdisciplinary Department for the Organization of Patient Pathways (DIOPP) , Villejuif, 94800,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Laure","family":"Martin","sequence":"additional","affiliation":[{"name":"UNICANCER Data and Partnerships Department, , Paris,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Jouffroy-Zeller","sequence":"additional","affiliation":[{"name":"UNICANCER Data and Partnerships Department, , Paris,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Lerebours","sequence":"additional","affiliation":[{"name":"Institut Curie Department of Medical oncology, , Saint-Cloud,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Rigal","sequence":"additional","affiliation":[{"name":"Centre Henri Becquerel Department of Medical oncology, , Rouen,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Fournier","sequence":"additional","affiliation":[{"name":"Institut Bergoni\u00e9 Department of Medical oncology, , Bordeaux,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Ange","family":"Mouret-Reynier","sequence":"additional","affiliation":[{"name":"Centre Jean Perrin Department of Medical oncology, , Clermont-Ferrand,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Campone","sequence":"additional","affiliation":[{"name":"Institut de Canc\u00e9rologie de L'ouest Department of Medical oncology, , Nantes Saint Herblain,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Tarpin","sequence":"additional","affiliation":[{"name":"Institut Paoli Calmettes Department of Medical oncology, , Marseille,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Guillermet","sequence":"additional","affiliation":[{"name":"Centre Eugene Marquis Department of Medical oncology, , Rennes,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvie","family":"Giacchetti","sequence":"additional","affiliation":[{"name":"H\u00f4pital Saint- Louis, AP-HP Department of Medical oncology, , Paris,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Petit","sequence":"additional","affiliation":[{"name":"Institut Strauss Department of Medical oncology, , Strasbourg,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Dalenc","sequence":"additional","affiliation":[{"name":"Oncopole Claudius Regaud Department of Medical oncology, , Toulouse,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agn\u00e8s","family":"Dumas","sequence":"additional","affiliation":[{"name":"INSERM, Aix Marseille Univ, IRD, ISSPAM, SESSTIM (Economic and Social Sciences of Health and Medical Information Processing), CALIPSO team , Marseille,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwenn","family":"Menvielle","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP , F-94805, Villejuif,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,29]]},"container-title":["JNCI: Journal of the National Cancer 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