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Till death do you part: Love, marriage, melanoma, and more


DII small banner By Warren R. Heymann, MD
May 21, 2018

 
“What brings you to the office today”?

“My wife wanted me to get my skin checked.”

If it wasn’t for wives, I wouldn’t have any male patients.

Seven years ago, my wife noted a lesion on my back, which proved to be a thin melanoma with a Breslow thickness of 0.3 mm. If I was single, who knows when, or if, it would have been noticed?

Buja et al assert: “Early cancer detection is fundamental to the promotion of better health in the community, but disparities remain in the likelihood of cancer being detected at an early stage, some of which relate to socio‐demographic factors such as marital status.” They performed a systematic review that confirmed the important influence of being married on the earlier detection of cancer. None of the studies considered identified more cases of cancer in a later stage among married patients.  The majority reported a positive effect of marriage on the likelihood of various cancers being diagnosed at an early stage. The meta‐analysis demonstrated that the unmarried have higher odds of having a later stage of breast cancer (OR = 1.287) or melanoma (OR = 1.350) at diagnosis. The authors recommended that specific interventions be developed for the unmarried to detect malignancies in their early stages. (1)
 
Merrill and Johnson performed analyses involving 779,978 males and 1,032,868 females diagnosed with 1 of 13 cancer types, derived from the Surveillance, Epidemiology, and End Results (SEER) Program. Regression models were adjusted for age, sex, race, and tumor stage. They found that five-year survival was higher among married patients with less lethal cancers (oral cavity and pharynx, colon and rectum, breast, urinary bladder, kidney and renal pelvis, melanoma of the skin, thyroid, lymphoma). For more lethal cancers, married patients had similar (liver, lung and bronchus, pancreas, leukemia) or poorer (brain and other nervous system) cancer survival. Separated/divorced or widowed patients had the lowest conditional relative survival rates. (2)

Spouses may encourage patients to seek medical evaluation for alarming signs or symptoms. The emotional stress of widowhood, accompanied by loss of income and social support, could leave the surviving spouse at risk for not seeking medical attention. (1)  Married individuals may have superior economic resources, better health promoting behaviors, and a stronger social network, each of which may extend cancer survival.  (2)

Sharon et al identified 52,063 melanoma patients from the SEER database (58.8% men and 41.2% women; median age, 64 years). Among married patients, 16,603 (45.7%) presented with T1a disease, compared with 3253 never married patients (43.0%), 1422 divorced patients (39.0%), and 1461 widowed patients (32.2%) (P < .001). Conversely, 428 widowed patients (9.4%) presented with T4b disease compared with 1188 married patients (3.3%) (P < .001). The association between marital status and higher T stage at presentation remained significant among never married (odds ratio [OR], 1.32), divorced (OR, 1.38), and widowed (OR, 1.70) patients after adjustment for various socioeconomic and patient factors. The authors suggest that there be increased emphasis on spousal training for partner examination, and perhaps more frequent screening for unmarried patients. (3)
 
Marriage may not be a panacea for cancer. Although the divorce rate may have actually decreased, it is still about 50% (4). In a fascinating study, Dinh et al, assessed 83,304 patients with two malignancies (from the SEER database) diagnosed 12 to 60 months apart. Patients were identified as newly divorced if married at their first diagnosis and single/divorced at their second. Newly divorced patients had the worst cancer-specific survival, which was statistically significant, followed by long-term divorcees. Newly married patients had similar cancer-specific survival compared to long-term marriages.  The authors encouraged appropriate cancer screening and support for recently divorced patients who may have had an acute disruption of their social support network. (5) More bad news — it’s not just cancer. Divorce has been associated with a higher risk of stroke, especially in men. (6)

Realistically, it probably isn’t marriage per se, that is beneficial, but rather being in a mutually loving, caring relationship where both partners are concerned about each other’s health.

When it comes to familial well-being, women rule the roost. The following is from Dr. Glenn Newell, my friend and internist, in describing his experience with cardiac disease as a seemingly healthy, fit man, in his essay “A Cyclist’s Heart” (7):

I started to notice when I would begin a ride a burning sensation in my throat and a deep ache in the palm of my hands. I thought at first that the throat burning was due to the recent sanding of the floors in my house and that the hand ache was that my cycling gloves were too tight. I offhandedly told my wife I was having these symptoms. She said get a stress test. I thought she was wrong — so I went to my Chief of Medicine who said “Glenn you are the healthiest guy I know, but when the wife says get a stress test then get one!”

Point to Remember: The lyrics from Cat Stevens’ “Father and Son”

It’s not time to make a change,
Just relax, take it easy
You’re still young, that’s your fault,
There’s so much you have to know
Find a girl, settle down,
If you want you can marry
Look at me, I am old, but I’m happy


(PS – Today, May 21st, is my 63rd birthday. I am forever grateful to my wonderful wife Ronnie for having discovered my cancers at ages 34 (seminoma) and 56 (melanoma). I know she’ll keep a vigilant eye on me — hopefully there’s nothing more to find!)

1. Buja A, et al. Marital status and stage of cancer at diagnosis. A systematic review. Eur J Cancer Care (Engl) 2018; doi: 10.1111/ecc.12755. Epub 2017 Aug 29.
2. Merrill RM, Johnson E. Benefits of marriage on relative and conditional relative cancer survival differ between males and femails in the USA. J Cancer Surviv 2017; 11: 578-589.
3. Sharon CE, et al. Association of marital status with T stage at presentation and management of early-stage melanoma. JAMA Dermatol 2018; 154: 574-80.
4. Abrams A. Divorce rate in U.S. drops to nearly 40-year low. Time. December 5, 2016.
5. Dinh KT, et al. Increased vulnerability to poorer cancer-specific outcomes following recent divorce. Am J Med 2018; 131: 517-23.
6. Andersen KK, Olsen TS. Married, unmarried, divorced and widowed and the risk of stroke. Acta Neurol Scand 2018; Mar 1 [Epub ahead of print].
7. Newell G. A cyclist’s heart. J Gen Pract (Los Angel) 2017; 5: 4.

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