The long-term financial consequences of breast cancer: a Danish registry-based cohort study

Laura Schärfe Jensen,Kirsten Fonager,Kim Overvad,Thomas Lund,Henrik Bøggild,Jens Peter Garne,Charlotte Overgaard

doi:10.1186/s12889-017-4839-x

Abstract

BackgroundA breast cancer diagnosis affects an individual’s affiliation to labour market, but the long-term consequences of breast cancer on income in a Danish setting have not been examined. The present study investigated whether breast cancer affected future income among Danish women that participated in the work force. We also examined the roles of sociodemographic factors and prior psychiatric medical treatment.MethodsThis registry-based cohort study was based on information retrieved from linked Danish nationwide registries. We compared the incomes of 13,101 women (aged 30–59 years) diagnosed with breast cancer (exposed) to those of 60,819 women without breast cancer (unexposed). Changes in income were examined during a 10-year follow-up; for each follow-up year, we calculated the mean annual income and the relative change compared to the income earned one year prior to diagnosis. Expected changes in Danish female income, according to calendar year and age, were estimated based on information from Statistics Denmark. For exposed and unexposed groups, the observed income changes were dichotomized to those above and those below the expected change in income in the Danish female population. We examined the impact of breast cancer on income each year of follow-up with logistic regression models. Analyses were stratified according to educational level, marital status, and prior psychiatric medical treatment.ResultsBreast cancer had a temporary negative effect on income. The effect was largest during the first three years after diagnosis; thereafter, the gap narrowed between exposed and unexposed cohorts. The odds ratio for an increase in income in the cancer cohort compared to the cancer-free cohort was 0.81 (95% CI 0.77–0.84) after three years. After seven years, no significant difference was observed between cohorts. Stratified analyses demonstrated that the negative effect of breast cancer on income lasted longest among women with high educational levels. Being single or having received psychiatric medical treatment increased the chance to experience an increase in income among women with breast cancer.ConclusionA breast cancer diagnosis led to negative effects on income, which ameliorated over the following seven years. Sociodemographic factors and prior psychiatric medical treatment might influence long-term consequences of breast cancer on income.

Highlights

A breast cancer diagnosis affects an individual’s affiliation to labour market, but the long-term consequences of breast cancer on income in a Danish setting have not been examined
Among women that participated in the work force, the unexposed group had a lower mean annual income compared to both of the exposed subgroups for all follow-up years (Fig. 2a)
Including women receiving permanent benefits in the study population, decreased the annual mean income for the two subgroups of women diagnosed with breast cancer, and caused that women diagnosed with stage IB-IV had a mean annual income below the mean annual income of cancer-free women in year two to six after the year of diagnosis (Fig. 3a)

Summary

Introduction

A breast cancer diagnosis affects an individual’s affiliation to labour market, but the long-term consequences of breast cancer on income in a Danish setting have not been examined. After a diagnosis and treatment of breast cancer, the ability to resume employment and a working lifestyle might have both short and long-term impacts on personal financial income. Previous studies have found a negative association between breast cancer and changes in personal income in the 1–3 years following a diagnosis of breast cancer, in Denmark [4, 5] and other Nordic countries [6,7,8,9]. The majority of studies has concentrated on the effect of breast cancer on changes in income in the first five years after diagnosis, but negative effects have been demonstrated in 9- and 13-year follow-up data [7, 9]. Real income is liable to change over time; for example, it was negative in Denmark in the late 2000’s, due to the Global Financial Crisis, after many years of positive development [13]

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