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Female white-collar workers remain at higher risk of breast cancer after adjustments for individual risk factors related to reproduction and lifestyle
  1. Cecilia Kullberg1,
  2. Jenny Selander1,
  3. Maria Albin1,2,
  4. Signe Borgquist3,
  5. Jonas Manjer3,4,
  6. Per Gustavsson1,2
  1. 1 Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  2. 2 Centre for Occupational and Environmental Medicine, Stockholms Lans Landsting, Stockholm, Sweden
  3. 3 Department of Clinical Sciences, Lunds Universitet, Lund, Sweden
  4. 4 Department of Surgery, Skåne University Hospital, Malmö, Sweden
  1. Correspondence to Cecilia Kullberg, Unit of Occupational Medicine, Institute of Environmental Medicine, Solnavägen 4, 10tr, Stockholm 113 65, Sweden; cecilia.kullberg{at}


Objectives The aim was to investigate the variation in risk of breast cancer between occupational groups with a focus on white-collar and blue-collar workers and to investigate to what extent the differences were explained by risk factors related to reproduction and lifestyle.

Methods Between 1991 and 1996, 14 119 women born between 1923 and 1950 and residents of Malmö, Sweden, were included in this cohort study. Individual data on risk factors (eg, age, parity, age at first child, months of breast feeding per child, hormonal replacement therapy, physical activity, alcohol consumption, smoking, height and body mass index) and occupational history were assessed using a questionnaire. First-time diagnoses of invasive breast cancer were identified through the Swedish Cancer Registry up until 31 December 2013.

Results A total of 897 women were diagnosed with breast cancer. Analyses adjusted for age showed an increased risk for white-collar workers compared with blue-collar workers and indicated higher risks in the occupational categories: professionals, administrative and bookkeeping than among women in sales, transportation, production and service work. This difference was only marginally attenuated after adjustment for an extensive set of risk factors related to reproduction and lifestyle.

Conclusion Reproductive and lifestyle factors explain only a minor part of the increased risk of breast cancer in white-collar workers. Further studies are needed to investigate the remaining factors for the difference in risk between occupational groups.

  • breast cancer
  • occupation
  • reproduction
  • lifestyle

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  • Acknowledgements The authors thank Håkan Andersson, IT coordinator at Skåne University Hospital, for data management. We also thank the occupational hygienists Pernilla Wiebert and Nils Plato for valuable input on the study design.

  • Contributors All authors participated in the conception and study design. CK, JS, JM, SB and PG took part in data collection. CK performed the analysis and CK, JS and PG prepared the first draft of the paper, while all authors took part in the discussion, interpretation and revision of the manuscript. All authors have read and approved the final version of the manuscript.

  • Funding Financial support was given by the Swedish Research Council for Health, Working Life and Welfare (FORTE).

  • Competing interests None declared.

  • Ethics approval Stockholm Ethical Review Board (Ref. 2014/233-31/4).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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