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. 2023 Apr 5:11:1129708.
doi: 10.3389/fpubh.2023.1129708. eCollection 2023.

Breast cancer and occupation: Non-parametric and parametric net survival analyses among Swiss women (1990-2014)

Irina Guseva Canu  1 , Nicolas Bovio  1 , Patrick Arveux  1 , Jean-Luc Bulliard  1   2 , Evelyne Fournier  3 , Simon Germann  1 , Isabelle Konzelmann  4 , Manuela Maspoli  2 , Elisabetta Rapiti  3 , Michel Grzebyk  5
Affiliations

Breast cancer and occupation: Non-parametric and parametric net survival analyses among Swiss women (1990-2014)

Irina Guseva Canu et al. Front Public Health. .

Abstract

Introduction: Occupation can contribute to differences in risk and stage at diagnosis of breast cancer. This study aimed at determining whether occupation, along with skill level and the socio-professional category, affect the breast cancer survival (BCS) up to 10 years after diagnosis.

Materials and methods: We used cancer registry records to identify women diagnosed with primary invasive breast cancer in western Switzerland over the period 1990-2014 and matched them with the Swiss National Cohort. The effect of work-related variables on BCS was assessed using non-parametric and parametric net survival methods.

Results: Study sample included 8,678 women. In the non-parametric analysis, we observed a statistically significant effect of all work-related variables on BCS. Women in elementary occupations, with low skill level, and in paid employment not classified elsewhere, had the lowest BCS, while professionals, those with the highest skill level and belonging to top management and independent profession category had the highest BCS. The parametric analysis confirmed this pattern. Considering elementary occupations as reference, all occupations but Craft and related trades had a hazard ratio (HR) below 1. Among professionals, technicians and associate professionals, and clerks, the protective effect of occupation was statistically significant and remained unchanged after adjustment for age, calendar period, registry, nationality, and histological type. After adjusting for tumor stage, the HRs increased only slightly, though turned non-significant. The same effect was observed in top management and independent professions and supervisors, low level management and skilled laborers, compared to unskilled employees.

Conclusion: These results suggest that work-related factors may affect BCS. Yet, this study was conducted using a limited set of covariates and a relatively small study sample. Therefore, further larger studies are needed for more detailed analyses of at risk occupations and working conditions and assessing the potential interaction between work-related variables and tumor stage.

Keywords: breast cancer; cancer registry; cohort; female worker; occupational epidemiology; occupational exposure; return to work.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Relationships between occupation and breast cancer experience for a working woman. Dot-lines correspond to the hypothesized relationships, which have not been studied yet. Question mark indicates the relationship investigated in this study. Text in red corresponds to examples of breast cancer risk factors, text in blue corresponds to examples of protective factors.
Figure 2
Figure 2
Non-parametric 10-year net survival of breast cancer across (A) occupation, (B) skill level required for the occupation, and (C) socio-professional category among women aged 18–85 in French-speaking Switzerland (1990–2014).
See this image and copyright information in PMC

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