{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T18:57:03Z","timestamp":1773341823812,"version":"3.50.1"},"reference-count":41,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities (NMHD) of the National Institutes of Health","doi-asserted-by":"publisher","award":["U54 MD 007582"],"award-info":[{"award-number":["U54 MD 007582"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Studies that have sought to describe and account for pre-diagnosed depressive symptoms on BC treatment choice, delay in initiating treatment, and mortality have been inconsistent. The purpose of the study is to examine the association between pre-diagnosed depressive symptoms and their impact on breast cancer (BC) treatment, treatment delays, and mortality. We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results\u2013Medicare Health Outcomes Survey (SEER-MHOS) dataset among women aged 65 years and older diagnosed with BC. Among 3840 eligible patients, 28.1% had pre-diagnosed depressive symptoms. Patients with pre-diagnosed depressive symptoms who were diagnosed with early-stage BC were significantly more likely (OR = 1.52; 95% CI: 1.26\u20131.84) to undergo mastectomy or receive breast-conserving surgery (BCS) alone rather than BCS plus radiation therapy (RT) compared to patients who were not pre-diagnosed with depressive symptoms. Among patients with advanced-stage BC, pre-diagnosed depressive symptoms were not significantly associated with treatment type. Among Hispanic patients, pre-diagnosed depressive symptoms were associated with treatment delays. Overall, patients with pre-diagnosed depressive symptoms had a 16% increased adjusted risk of BC-related mortality compared to those who were not pre-diagnosed with depressive symptoms, and those with advanced-stage cancer had an 18% higher adjusted risk of death than early-stage BC. Conclusions: Overlooking depressive symptoms management prior to a breast cancer diagnosis may result in poorer survival outcomes. Early detection and consistent management of depression are critical for improving patient survival.<\/jats:p>","DOI":"10.3390\/ijerph23030361","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T09:23:03Z","timestamp":1773307383000},"page":"361","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Pre-Diagnosed Depressive Symptoms on Treatment Choice, Delay in Initiating Treatment, and Mortality Among Women Aged \u226565 Years with Breast Cancer"],"prefix":"10.3390","volume":"23","author":[{"given":"David","family":"Gbogbo","sequence":"first","affiliation":[{"name":"College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A & M University, Tallahassee, FL 32307, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7256-118X","authenticated-orcid":false,"given":"Rima","family":"Tawk","sequence":"additional","affiliation":[{"name":"College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A & M University, Tallahassee, FL 32307, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Askal A.","family":"Ali","sequence":"additional","affiliation":[{"name":"Economic Social & Administrative Pharmacy, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A & M University, Tallahassee, FL 32307, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7983-7791","authenticated-orcid":false,"given":"Carlos A.","family":"Reyes-Ortiz","sequence":"additional","affiliation":[{"name":"College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A & M University, Tallahassee, FL 32307, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gebre-Egziabher","family":"Kiros","sequence":"additional","affiliation":[{"name":"College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A & M University, Tallahassee, FL 32307, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1016\/S0140-6736(16)31891-8","article-title":"Breast cancer","volume":"389","author":"Harbeck","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"djx030","DOI":"10.1093\/jnci\/djx030","article-title":"Annual Report to the Nation on the Status of Cancer, 1975\u20132014, Featuring Survival","volume":"109","author":"Jemal","year":"2017","journal-title":"J. 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