Purpose <p>This study explored changes in employment and financial hardship following breast cancer diagnosis.</p> Methods <p>We used data from a single-institution, longitudinal study of women with newly diagnosed breast cancer who received curative intent chemotherapy. The primary outcomes of interest in this analysis were breaks in active employment, defined as being out of work for the four weeks prior, and patient-reported acute financial burden during chemotherapy and up to 24&#xa0;months following chemotherapy completion. Mixed-effects logistic regression models were used to identify factors associated with breaks in employment and financial burden.</p> Results <p>The cohort consisted of 104 women who were employed at time of breast cancer diagnosis. The mean age was 49.6&#xa0;years and 86% were non-Hispanic White, 11% African American or Black, and 4% another race or ethnicity. In multivariable models, African-American women were 168% more likely to report a break from active employment than their non-Hispanic white counterparts (adjusted odds ration [aOR] 2.68; <i>p</i> = 0.026). A break from active employment was not statistically associated with greater self-reported acute financial burden, but patients from the lowest socioeconomic status tertile were 173% more likely to report financial burden than those in the highest tertile (aOR 2.73; <i>p</i> = 0.022).</p> Conclusion <p>African-American breast cancer survivors were more likely to report breaks from active employment than their White peers, even after adjusting for type of work and socioeconomic status.</p> Implication for cancer survivors <p>African-American and Black breast cancer survivors may face greater challenges returning to work.</p>