Abstract P5-13-14: Marital status is associated with late stage presentation in patients with breast cancer
Authors: Benitez CM , Balazy KE , von Eyben R , Horst KC 
Published: May 2019

Abstract
Objective: To determine whether marital status is associated with late stage presentation for breast cancer patients
Materials/Methods: Patients with breast cancer treated with radiation therapy at a single institution from 2012-2017 were identified (n=1060). There were 189 patients with stage 0/DCIS, 442 with stage I, 318 with stage II, 74 with stage III, and 38 with stage IV disease. Patients were categorized by marriage status as single, married, divorced, or widowed. A logistic regression model was run using stage as the outcome to analyze odds ratios for late stage presentation (stages III and IV) based on marital status. The model included age, ethnicity/race, insurance, marital status, and language. Additional interactions between age and ethnicity/race, and ethnicity/race and insurance improved the fit of the model and were also included. All odds ratios were interpreted against the reference subset defined as white, married, English-speaking patients with public insurance.
Results: There was a significant association between marital status and stage of presentation, most notably for widowed patients. Widowed patients have 2.04 odds of presenting with late stage disease compared to married patients (95% CI 1.20-3.47). Additionally, single patients present at an earlier stage than widowed patients, and have 0.50 odds of late stage disease compared to widowed patients (95% CI 0.28-0.91).There was a trend towards divorced patients having a higher odds of late stage presentation, however, it was not statistically significant. Divorced patients had1.33 times the odds of having late stage disease compared to the married patients (95% CI 0.90-1.96), and 1.30 times the odds of having late stage disease compared to the single patients (95% CI 0.82-2.06). However, relative to widowed patients, the divorced patients have lower odds of presenting with late stage disease (OR=0.65, 95% CI 0.35-1.21). Interestingly, there is no statistically significant difference between single and married patients for stage of presentation (OR=1.03, CI 0.75-1.41).
Conclusion: Marital status is correlated with late stage presentation, especially for widowed patients. Interestingly single and married patients had almost identical probabilities of presenting with all stages of disease. They had the highest probability of having stage 0/DCIS or stage I disease, and the lowest probability of stage III or stage IV disease. Divorcees had a trend towards late stage presentation, with a smaller probability of stage 0/DCIS and stage I disease, and greater probability for stage III and stage IV disease. The biggest difference was seen for widowed patients who had the smallest probability of stage 0/DCIS or stage I disease, and the greatest probability of having stage III or stage IV disease. Widowed patients had higher odds of presenting with late stage disease than both single patients and married patients. It remains to be explored why this population is more vulnerable to late stage breast cancer presentation than their single, married, and divorced counterparts.
Citation Format: Benitez CM, Balazy KE, von Eyben R, Horst KC. Marital status is associated with late stage presentation in patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-14.