title: The effect of marital status on breast cancer-related outcomes in women under 65: A SEER database analysis.
abstract: BACKGROUND
  Marital status is strongly associated with improved health and longevity. Being married has been shown to be positively associated with survival in patients with multiple different types of malignancy; however, little is known about the relationship between marital status and breast cancer in younger women. The purpose of this study is to investigate the effect of marital status on diagnosis, and survival of women under the age of 65 with breast cancer.
  
  
  METHODS
  The SEER 18 regions database was used to identify women between the ages of 25-64 diagnosed with invasive breast cancer in the years 2004-2009. Logistic regression was used to predict later stage diagnosis by marital status and Cox proportional hazards models were used to compare breast cancer-related and all-cause survival by marital status classification. Models were stratified by AJCC stage.
  
  
  RESULTS
  After adjusting for age, race, and ER status, unmarried women were 1.18 times more likely to be diagnosed at a later stage than married women (95% CI 1.15, 1.20). In adjusted analysis unmarried women were more likely to die of breast cancer and more likely to die of all causes than married women across all AJCC stages.
  
  
  CONCLUSIONS
  Younger unmarried women with breast cancer may benefit from additional counseling, psychosocial support and case management at the time of diagnosis to ensure their overall outcomes are optimized.
authors.affiliation: Saint Louis University Center for Outcomes Research, 3545 Lafayette Ave., Salus Center, Room 409, Saint Louis, MO 63104, USA. Electronic address: hinyardl@slu.edu.
authors.forename: Leslie
authors.initials: L
authors.lastname: Hinyard
authors.affiliation: Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave., Salus Center, Room 409, Saint Louis, MO 63104, USA. Electronic address: lorinettewillia@slu.edu.
authors.forename: Lorinette Saphire
authors.initials: LS
authors.lastname: Wirth
authors.affiliation: Saint Louis University School of Medicine, 1402 S Grand Blvd., Saint Louis, MO 63104, USA. Electronic address: clancyj@slu.edu.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Clancy
authors.affiliation: Saint Louis University Department of Surgery, 3655 Vista Ave., Saint Louis, MO 63104, USA. Electronic address: schwartl@slu.edu.
authors.forename: Theresa
authors.initials: T
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D017533:Marital Status; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018426:SEER Program; D012944:Social Support; D015996:Survival Rate; D055815:Young Adult
keywords: Breast neoplasms; Epidemiology; Marital status; SEER program; Survival analyses; Women