Explaining educational differences in return to work after early breast cancer: a mediation analysis.

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