The influence of marital status and race/ethnicity on risk of mortality for triple negative breast cancer.

Carol Parise,Vincent Caggiano,Robert M Lafrenie

doi:10.1371/journal.pone.0196134

Abstract

PurposeTo assess the effect of marital status and the role of race/ethnicity on breast cancer specific mortality in women with triple negative breast cancer (TNBC).MethodsThe study utilized the California Cancer Registry to identify 22,812 cases of first primary female TNBC. Unadjusted Kaplan-Meier breast cancer specific survival was computed. Cox Proportional Hazards modeling was used to compute the adjusted risk of breast cancer specific mortality for women who were single, separated, divorced, and widowed when compared with women who were married. Models were adjusted for age, stage, tumor grade, SES, and treatment with surgery, chemotherapy, hormone therapy, and radiation therapy. Hazard ratios (HR) and 95% confidence intervals (CI) were reported.ResultsSeparated (HR: 1.45; 95% CI: 1.14–2.01) and widowed (HR: 1.39; 95%CI: 1.23–1.57) white women had a higher risk of mortality than white married women whereas single and divorced white women had the same risk of mortality. For Asian/Pacific Islanders (API), only single (HR: 1.55; 95% CI: 1.17–2.06) and divorced (HR:1.81; 95% CI:1.26–2.60) women had a higher risk of mortality than married women. Marital status had no influence on risk of mortality for either black or Hispanic women.ConclusionsThe risk of mortality associated with marital status is dependent on race/ethnicity. Only white and API women with TNBC have a marital advantage.

Highlights

Breast cancer is the most common cancer among women but it is a heterogeneous disease and there is variability in both incidence and survival among breast cancer subtypes
Separated (HR: 1.45; 95% confidence intervals (CI): 1.14–2.01) and widowed (HR: 1.39; 95%CI: 1.23–1.57) white women had a higher risk of mortality than white married women whereas single and divorced white women had the same risk of mortality
For Asian/Pacific Islanders (API), only single (HR: 1.55; 95% CI: 1.17–2.06) and divorced (HR:1.81; 95% CI:1.26–2.60) women had a higher risk of mortality than married women

Summary

Introduction

Breast cancer is the most common cancer among women but it is a heterogeneous disease and there is variability in both incidence and survival among breast cancer subtypes. When all breast cancer subtypes are combined and breast cancer is considered a single disease, tumor characteristics such as stage at diagnosis and tumor grade as well as social factors including race/ethnicity and marital status have been found to be associated with both breast cancer incidence and survival. The purpose of this study is to assess the effect of marital status on breast cancer specific mortality in women with TNBC and evaluate the role of race/ethnicity on this association. (ICDO-3 sites C50.0-C50.9) [16] Cases had complete data for tumor size, grade, American Joint Commission on Cancer (AJCC) stage of diagnosis, surgery (lumpectomy, mastectomy), chemotherapy, hormone therapy, radiation therapy, cause of death, age, socioeconomic status (SES), marital status, and race/ethnicity. The study was categorized as exempt from institutional review board oversight

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