Journal of Cancer Survivorship

, Volume 4, Issue 4, pp 372–380 | Cite as

Social networks and survival after breast cancer diagnosis

  • Jeannette M. Beasley
  • Polly A. Newcomb
  • Amy Trentham-Dietz
  • John M. Hampton
  • Rachel M. Ceballos
  • Linda Titus-Ernstoff
  • Kathleen M. Egan
  • Michelle D. Holmes



Evidence has been inconsistent regarding the impact of social networks on survival after breast cancer diagnosis. We prospectively examined the relation between components of social integration and survival in a large cohort of breast cancer survivors.


Women (N = 4,589) diagnosed with invasive breast cancer were recruited from a population-based, multi-center, case-control study. A median of 5.6 years (Interquartile Range 2.7–8.7) after breast cancer diagnosis, women completed a questionnaire on recent post-diagnosis social networks and other lifestyle factors. Social networks were measured using components of the Berkman-Syme Social Networks Index to create a measure of social connectedness. Based on a search of the National Death Index, 552 deaths (146 related to breast cancer) were identified. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression.


Higher scores on a composite measure of social connectedness as determined by the frequency of contacts with family and friends, attendance of religious services, and participation in community activities was associated with a 15–28% reduced risk of death from any cause (p-trend = 0.02). Inverse trends were observed between all-cause mortality and frequency of attendance at religious services (p-trend = 0.0001) and hours per week engaged in community activities (p-trend = 0.0005). No material associations were identified between social networks and breast cancer-specific mortality.


Engagement in activities outside the home was associated with lower overall mortality after breast cancer diagnosis.


Cancer Oncology Breast cancer Survival Mortality Social networks 



This work was supported by The Susan B. Komen For the Cure Foundation (POP 0504234) and NIH grants CA47147 and CA47305.


  1. 1.
    House JS, Landis KR, Umberson D. Social relationships and health. Science (New York, NY). 1988;241:540–5.Google Scholar
  2. 2.
    Pinquart M, Duberstein PR. Associations of social networks with cancer mortality: A meta-analysis. Crit Rev Oncol/Hematol. 2009.Google Scholar
  3. 3.
    Falagas ME, Zarkadoulia EA, Ioannidou EN, Peppas G, Christodoulou C, Rafailidis PI. The effect of psychosocial factors on breast cancer outcome: a systematic review. Breast cancer Res: BCR. 2007;9:R44.CrossRefPubMedGoogle Scholar
  4. 4.
    Marshall JR, Funch DP. Social environment and breast cancer. A cohort analysis of patient survival. Cancer. 1983;52:1546–50.CrossRefPubMedGoogle Scholar
  5. 5.
    Reynolds P, Boyd PT, Blacklow RS, Jackson JS, Greenberg RS, Austin DF, et al. The relationship between social ties and survival among black and white breast cancer patients. National Cancer Institute Black/White Cancer Survival Study Group. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive. Oncology. 1994;3:253–9.Google Scholar
  6. 6.
    Weihs KL, Enright TM, Simmens SJ. Close relationships and emotional processing predict decreased mortality in women with breast cancer: preliminary evidence. Psychosom Med. 2008;70:117–24.CrossRefPubMedGoogle Scholar
  7. 7.
    Kroenke CH, Kubzansky LD, Schernhammer ES, Holmes MD, Kawachi I. Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol. 2006;24:1105–11.CrossRefPubMedGoogle Scholar
  8. 8.
    Greer S, Morris T, Pettingale KW. Psychological response to breast cancer: effect on outcome. Lancet. 1979;2:785–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Cassileth BR, Walsh WP, Lusk EJ. Psychosocial correlates of cancer survival: a subsequent report 3 to 8 years after cancer diagnosis. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 1988;6:1753–9.Google Scholar
  10. 10.
    Barraclough J, Osmond C, Taylor I, Perry M, Collins P. Life events and breast cancer prognosis. BMJ (Clinical research ed). 1993;307:325.CrossRefGoogle Scholar
  11. 11.
    Butow PN, Coates AS, Dunn SM. Psychosocial predictors of survival: metastatic breast cancer. Ann Oncol. 2000;11:469–74.CrossRefPubMedGoogle Scholar
  12. 12.
    Osborne RH, Sali A, Aaronson NK, Elsworth GR, Mdzewski B, Sinclair AJ. Immune function and adjustment style: do they predict survival in breast cancer? Psycho-oncology. 2004;13:199–210.CrossRefPubMedGoogle Scholar
  13. 13.
    Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet. 1989;2:888–91.CrossRefPubMedGoogle Scholar
  14. 14.
    Kissane DW, Grabsch B, Clarke DM, Smith GC, Love AW, Bloch S, et al. Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial. Psycho-oncology. 2007;16:277–86.CrossRefPubMedGoogle Scholar
  15. 15.
    Coyne JC, Hanisch LJ, Palmer SC. Psychotherapy does not promote survival (Kissane et al., 2007): now what? Psycho-oncology. 2007;16:1050–2.CrossRefPubMedGoogle Scholar
  16. 16.
    Spiegel D, Butler LD, Giese-Davis J, Koopman C, Miller E, DiMiceli S, et al. Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: a randomized prospective trial. Cancer. 2007;110:1130–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Seeman TE, Kaplan GA, Knudsen L, Cohen R, Guralnik J. Social network ties and mortality among the elderly in the Alameda County Study. Am J Epidemiol. 1987;126:714–23.PubMedGoogle Scholar
  18. 18.
    Seeman TE, Berkman LF, Kohout F, Lacroix A, Glynn R, Blazer D. Intercommunity variations in the association between social ties and mortality in the elderly. A comparative analysis of three communities. Ann Epidemiol. 1993;3:325–35.CrossRefPubMedGoogle Scholar
  19. 19.
    Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, et al. No health without mental health. Lancet. 2007;370:859–77.CrossRefPubMedGoogle Scholar
  20. 20.
    Spiegel D, Kato PM. Psychosocial influences on cancer incidence and progression. Harv Rev Psychiatry. 1996;4:10–26.CrossRefPubMedGoogle Scholar
  21. 21.
    Christakis NA, Fowler JH. The collective dynamics of smoking in a large social network. N Engl J Med. 2008;358:2249–58.CrossRefPubMedGoogle Scholar
  22. 22.
    Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med. 2007;357:370–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2005;23:5814–30.Google Scholar
  24. 24.
    Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychosocial factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008;5:466–75.CrossRefPubMedGoogle Scholar
  25. 25.
    Kopp MS, Skrabski A, Szekely A, Stauder A, Williams R. Chronic stress and social changes: socioeconomic determination of chronic stress. Ann NY Acad Sci. 2007;1113:325–38.CrossRefPubMedGoogle Scholar
  26. 26.
    McGregor BA, Antoni MH, Boyers A, Alferi SM, Blomberg BB, Carver CS. Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. J Psychosom Res. 2004;56:1–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Amorim VM, Barros MB, Cesar CL, Carandina L, Goldbaum M. Factors associated with lack of mammograms and clinical breast examination by women: a population-based study in Campinas, Sao Paulo State, Brazil. Cad Saude Publica. 2008;24:2623–32.CrossRefPubMedGoogle Scholar
  28. 28.
    Fowler BA. The influence of social support relationships on mammography screening in African-American women. J Natl Black Nurses Assoc. 2007;18:21–9.PubMedGoogle Scholar
  29. 29.
    Nausheen B, Gidron Y, Peveler R, Moss-Morris R. Social support and cancer progression: a systematic review. J Psychosom Res. 2009;67:403–15.CrossRefPubMedGoogle Scholar
  30. 30.
    Longnecker MP, Newcomb PA, Mittendorf R, Greenberg ER, Clapp RW, Bogdan GF, et al. Risk of breast cancer in relation to lifetime alcohol consumption. J Natl Cancer Inst. 1995;87:923–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Titus-Ernstoff L, Egan KM, Newcomb PA, Baron JA, Stampfer M, Greenberg ER, et al. Exposure to breast milk in infancy and adult breast cancer risk. J Natl Cancer Inst. 1998;90:921–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Sprague BL, Trentham-Dietz A, Newcomb PA, Titus-Ernstoff L, Hampton JM, Egan KM. Lifetime recreational and occupational physical activity and risk of in situ and invasive breast cancer. Cancer Epidemiol Biomarkers Prev. 2007;16:236–43.CrossRefPubMedGoogle Scholar
  33. 33.
    Calle EE, Terrell DD. Utility of the National Death Index for ascertainment of mortality among cancer prevention study II participants. Am J Epidemiol. 1993;137:235–41.PubMedGoogle Scholar
  34. 34.
    Berkman LF, Syme SL. Social networks, host resistance, and mortality: a 9-year follow-up study of Alameda County residents. Am J Epidemiol. 1979;109:186–204.PubMedGoogle Scholar
  35. 35.
    Sapp AL, Trentham-Dietz A, Newcomb PA, Hampton JM, Moinpour CM, Remington PL. Social networks and quality of life among female long-term colorectal cancer survivors. Cancer. 2003;98:1749–58.CrossRefPubMedGoogle Scholar
  36. 36.
    Lehto US, Ojanen M, Dyba T, Aromaa A, Kellokumpu-Lehtinen P. Baseline psychosocial predictors of survival in localised breast cancer. Br J Cancer. 2006;94:1245–52.CrossRefPubMedGoogle Scholar
  37. 37.
    Rutledge T, Linke SE, Olson MB, Francis J, Johnson BD, Bittner V, et al. Social networks and incident stroke among women with suspected myocardial ischemia. Psychosom Med. 2008;70:282–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Ramsay S, Ebrahim S, Whincup P, Papacosta O, Morris R, Lennon L, et al. Social engagement and the risk of cardiovascular disease mortality: results of a prospective population-based study of older men. Ann Epidemiol. 2008;18:476–83.CrossRefPubMedGoogle Scholar
  39. 39.
    Holick CN, Newcomb PA, Trentham-Dietz A, Titus-Ernstoff L, Bersch AJ, Stampfer MJ, et al. Physical activity and survival after diagnosis of invasive breast cancer. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2008;17:379–86.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Jeannette M. Beasley
    • 1
  • Polly A. Newcomb
    • 2
    • 3
  • Amy Trentham-Dietz
    • 3
  • John M. Hampton
    • 3
  • Rachel M. Ceballos
    • 2
  • Linda Titus-Ernstoff
    • 4
  • Kathleen M. Egan
    • 5
  • Michelle D. Holmes
    • 6
  1. 1.Cancer Prevention ProgramFred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Cancer Prevention ProgramFred Hutchinson Cancer Research CenterSeattleUSA
  3. 3.University of Wisconsin Paul P. Carbone Comprehensive Cancer CenterMadisonUSA
  4. 4.Dartmouth Medical SchoolLebanonUSA
  5. 5.H. Lee Moffitt Cancer Center & Research InstituteTampaUSA
  6. 6.Channing Laboratory, Harvard Medical School, Brigham & Women’s HospitalBostonUSA

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