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    Contents lists available at ScienceDirect
    The Breast
    Original article
    Causes of sick leave, disability pension, and death following a breast cancer diagnosis in women of working age
    Anna Plym a, *, Anna L.V. Johansson a, b, Hannah Bower a, Margaretha Voss c, Lars Holmberg d, e, Irma Fredriksson f, g, Mats Lambe a, h
    a Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
    b Cancer Registry of Norway, Oslo, Norway
    c Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    d Translational Urology and Oncology Research, Division of Cancer Studies, King's College London, London, UK
    e Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
    f Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
    g Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
    h Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden
    Article history:
    Received in revised form
    Breast cancer
    Cause of death
    Disability pension
    Mental disorders
    Sick leave 
    Objectives: Women diagnosed with breast cancer during working age are transition reaction at increased risk of permanent absence from work, but the underlying medical causes have rarely been studied. We examined the risk of cause-specific sick leave, 146724-94-9 disability pension, and the competing event death after a breast cancer diag-nosis in a population-based cohort study.
    Materials and methods: From the Breast Cancer Data Base Sweden, we identified 16,603 women diag-nosed with stage I-III breast cancer between 2000 and 2012, and 63,773 control women. Using multi-state modelling, we calculated probabilities and durations of sick leave, disability pension, and death by registered cause, together with cause-specific hazard ratios.
    Results: Five years after diagnosis, causes other than cancer accounted for around half of all sick leave (3.5% out of 6.8% of women) and disability pension (1.4% out of 2.6%) in women with breast cancer. Compared with control women, women with breast cancer were at increased risk of sick leave and disability pension due to mental disorders (HR 1.24, 95% CI 1.15e1.33 and HR 1.54, 95% CI 1.29e1.85, respectively) and disability pension due to inflammatory diseases (HR 1.46, 95% CI 1.05e2.03). The risk of sick leave and disability pension due to cardiovascular disease was also elevated, although only statis-tically significant for disability pension in women diagnosed after 2005 (HR 2.24, 95% CI 1.22e4.13).