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Cox proportional hazards model stratified by treatment arm\/study was used to examine the effect of education on survival among patients with early stage and metastatic breast cancer, after adjustment for known prognostic factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The patient population included 1020 patients with metastatic disease and 5146 patients with early stage disease. Among metastatic patients, factors associated with poorer survival in the final multivariable model included African American race, never married, negative estrogen receptor status, prior hormonal therapy, visceral involvement, and bone involvement. Among early stage patients, significant factors associated with poorer survival included African American race, separated\/widowed, post\/perimenopausal, negative\/unknown estrogen receptor status, negative progesterone receptor status, &gt;4 positive nodes, tumor diameter &gt;2\u2009cm, and education. Having not completed high school was associated with poorer survival among early stage patients. Among metastatic patients, non\u2010African American women who lacked a high school degree had poorer survival than other non\u2010African American women, and African American women who lacked a high school education had better survival than educated African American women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Having less than a high school education is a risk factor for death among patients with early stage breast cancer who participated in a clinical trial, with its impact among metastatic patients being less clear. Post\u2010trial survivorship plans need to focus on women with low social status, as measured by education. Copyright \u00a9 2011 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pon.2094","type":"journal-article","created":{"date-parts":[[2011,10,21]],"date-time":"2011-10-21T12:39:10Z","timestamp":1319200750000},"page":"315-323","source":"Crossref","is-referenced-by-count":34,"title":["Effect of socioeconomic status as measured by education level on survival in breast cancer clinical trials"],"prefix":"10.1002","volume":"22","author":[{"suffix":"II","given":"James E.","family":"Herndon","sequence":"first","affiliation":[{"name":"Department of Biostatistics &amp; Bioinformatics Duke University Medical Center Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice B.","family":"Kornblith","sequence":"additional","affiliation":[{"name":"Dana Farber Cancer Institute Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmie C.","family":"Holland","sequence":"additional","affiliation":[{"name":"Memorial 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