研究背景：臺灣自1994年以來，乳癌便持續為我國女性癌症發生率的第一位。且依據我國2020年癌症登記年報數據顯示，處於法定退休年齡65歲以下被診斷出乳癌之女性，占全年齡女性乳癌的73.0%。雖隨著臺灣乳癌篩檢計劃的推行及治療方式的進步，乳癌的五年存活率有顯著的增加，若能早期診斷早期治療，五年存活率可達90％以上。但這也意味著更多處於工作年齡的女性乳癌倖存者，在其工作階段可能被迫因乳癌或其治療後遺症而有被播離開職場的狀況，造成女性勞動人口的流失。因此有探討臺灣受僱女性勞工乳癌診斷前後之工作軌跡及其影響因素之重要性。
研究目的：為探討臺灣新發女性乳癌受僱勞工之工作歷程，本研究主要研究目的可分為三點：首先，分析乳癌診斷後工作率變動情形。其次，探討乳癌勞工於診斷後四年無工作之影響因素。最後，探討乳癌勞工於診斷前兩年至後四年之工作軌跡及影響因素。
研究方法：本研究採回溯性世代追蹤研究設計，首先依癌症登記檔長表（LF）撈取自2010年1月1日至2013年12月31日間被初次診斷患有乳癌之30-59歲女性患者，並透過勞動部勞就保被保險人檔及全民健保承保檔（ID）共同判定其於診斷日該月及其前兩個月必需具有至少一筆勞保投保紀錄者，作為本研究之乳癌勞工樣本，而後將其診斷日定義為指標日（T0），藉此配對選取非乳癌女性受僱勞工樣本。在分析乳癌診斷後工作率變動情形時，除了計算兩組樣本於指標日後四年內，每一年之工作率外，亦採用條件式邏輯斯迴歸分析（Conditional logistic regression）探討乳癌對受僱勞工所帶來的勞動衝擊。而後採用多變項羅輯斯迴歸（Multiple logistic regression），針對乳癌勞工探討其於指標日後四年無工作之影響因素。最後，以群組化軌跡模式（Group-based trajectory modelling, GBTM）探討乳癌勞工於乳癌診斷前兩年至後四年之工作軌跡，並以多類別邏輯斯迴歸（Multinomial logistic regression）探討不同軌跡分組背後之影響因素。以上分析策略均考慮社會人口學與臨床及治療變項進行校正。
研究結果：本研究共收錄10,904名新發女性乳癌受僱勞工，並其依指標日配對10,904名非乳癌女性勞工，作為研究樣本進行工作歷程的相關探討。結果顯示乳癌勞工於指標日（T0）後第12；24、36，及48個月之工作率，依序為90.4%、88.5%、86.0%、84.5%，呈現逐年下降之趨勢。而在探討乳癌診斷後工作率變動情形中，針對乳癌對女性勞工之工作衝擊進行量化，不只發現乳癌在各追蹤時間點皆是轉變為無工作的重要危險因子（以戶籍地位於北部、婚姻狀況為有偶、投保薪資≧60,000元，及指標日前一年共病指標為0分之個案為例，四個觀察時間的OR: 2.55、2.77、1.87、1.98，皆達顯著意義），還觀察到共病對於樣本於追蹤期間各時間點無工作的影響，在乳癌勞工中被削弱的現象。而乳癌勞工轉為無工作之影響因素的部分，則發現高年齡、低教育程度、低投保薪資、戶籍地之鄉鎮市區別為市者、未婚者、第III-IV期乳癌診斷期別者、接受「手術+化療」者，有較高的可能性在追蹤期間工作狀態轉變無工作。在工作軌跡的部分，則發現無論是全乳癌勞工、第0-II期30-49歲乳癌勞工，還是第0-II期50-59歲乳癌勞工，其工作軌跡均可歸類為維持工作組、延緩失業組，及急速失業組，共三組。且除了年齡及乳癌診斷期別之外，低教育程度及低投保薪資亦是導致乳癌勞工流入急速失業組的重要危險因子。
結論：透過本研究結果得知乳癌的確會造成女性受僱勞工在工作歷程上的衝擊，且經由年齡與乳癌診斷期別的分層分析中，可知在不同分層下，乳癌對女性勞工之勞動衝擊亦不盡相同。凸顯後續研究需進一步針對乳癌患者之年齡與診斷期別分別探討的重要性。而本研究所採用之工作軌跡分析策略，亦解決過去研究之缺陷，彌補本研究領域知識缺口。未來研究可以進一步朝向探討乳癌對於患者薪資收入所帶來之衝擊，又或是探討乳癌勞工在經歷乳癌診斷後工作或行業別的轉變情形進行努力。並透過質性研究加以輔助，探討乳癌勞工離開職場的原因，作為中央政府制定工作相關支持性政策的可靠證據。

Since 1994, the incidence of breast cancer has become the first place of of all the female cancer in Taiwan. And over 73.9% of women who were diagnosed with breast cancer are under the legal retirement age of 65 in 2019. And due to breast cancer's high survival rate. It is important to explore the working trajectories and the influencing factors of employed female workers in Taiwan.
According to the results, we know that breast cancer indeed have an impact on the working status of female workers, and stratified by age and the stage of breast cancer diagnosis, we can see the different impact under these stratifications. Furtherrmore, the group-based trajectory modeling which was adopted in this research also shows that the breast cancer workers' working trajectories can be classified as three groups of maintenance work group , delayed unemployment group, and rapid unemployment group.
Base on the further analysis of risk factors, our study can help identify the vulnerable breast cancer workers who may rapid leave from the workforce. And be the reliable evidence for the central government to formulate supportive work-related policies.

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