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PLoS One. 2017 May 5;12(5):e0175515. doi: 10.1371/journal.pone.0175515. eCollection 2017.

Prognostic significance of marital status in breast cancer survival: A population-based study.

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Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States of America.
Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America.
Department of Surgery, University of California, San Diego, La Jolla, CA, United States of America.
Cancer Prevention Institute of California, Fremont, CA, United States of America.
Kaiser Permanente, Division of Research, Oakland, CA, United States of America.
Maricopa Medical Center, Department of Surgery, Phoenix, AZ, United States of America.
Stanford Cancer Institute, Palo Alto, CA, United States of America.


Research shows that married cancer patients have lower mortality than unmarried patients but few data exist for breast cancer. We assessed total mortality associated with marital status, with attention to differences by race/ethnicity, tumor subtype, and neighborhood socioeconomic status (nSES). We included, from the population-based California Cancer Registry, women ages 18 and older with invasive breast cancer diagnosed between 2005 and 2012 with follow-up through December 2013. We estimated mortality rate ratios (MRR) and 95% confidence intervals (CI) for total mortality by nSES, race/ethnicity, and tumor subtype. Among 145,564 breast cancer cases, 42.7% were unmarried at the time of diagnosis. In multivariable-adjusted models, the MRR (95% CI) for unmarried compared to married women was 1.28 (1.24-1.32) for total mortality. Significant interactions were observed by race/ethnicity (P<0.001), tumor subtype (P<0.001), and nSES (P = 0.009). Higher MRRs were observed for non-Hispanic whites and Asians/Pacific Islanders than for blacks or Hispanics, and for HR+/HER2+ tumors than other subtypes. Assessment of interactive effect between marital status and nSES showed that unmarried women living in low SES neighborhoods had a higher risk of dying compared with married women in high SES neighborhoods (MRR = 1.60; 95% CI: 1.53-1.67). Unmarried breast cancer patients have higher total mortality than married patients; the association varies by race/ethnicity, tumor subtype, and nSES. Unmarried status should be further evaluated as a breast cancer prognostic factor. Identification of underlying causes of the marital status associations is needed to design interventions that could improve survival for unmarried breast cancer patients.

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