Marriage Won't Affect Breast Cancer Prognosis

Marital status does not affect the prognosis for women with early stage breast cancer who are treated with lumpectomy and radiation.

This finding, presented Sunday in Denver at the 47th annual meeting of the American Society for Therapeutic Radiology and Oncology, is in contrast with previous cancer research.

It's unclear how the results will influence treatment decisions, other than to reassure women that, whether they are single, married, widowed or divorced, their prognosis is the same, says Dr.

Jay Brooks, chairman of hematology/oncology at the Ochsner Clinic Foundation in Baton Rouge, La.

Dr. Shelly B. Hayes, lead author of the study and chief resident in the radiation oncology department at Fox Chase Cancer Center in Philadelphia, borrowed the idea for the study from similar research done on survival rates of men and women with head and neck cancer who underwent radiotherapy.

In those cases, men who did better in terms of survival were married, although there was no apparent association between survival and marital status for women.

The differences may have been attributable to psychosocial factors. For someone with head and neck cancer, every day of treatment missed decreases the cure rate by 3 percent. Married men, it is surmised, may be more compliant with treatment, with their wives making sure they get to treatment sessions, researchers says.

Women also may be getting themselves to treatment sessions.

"Women, in general, tend to be more compliant with treatment than men," Hayes notes.

Women with breast cancer are an entirely different patient population, however. "People with head and neck cancer are generally smokers and drinkers," Hayes explains. "The risk factors are quite different than for breast cancer, so there's a whole set of psychosocial issues that generally aren't present with breast cancer patients."

Hayes' study involved 2,143 women with early stage breast cancer treated with both lumpectomy and radiation at Fox Chase Cancer Center between 1984 and 2003.

Participants were divided into four groups based on marital status: married (63 percent), single (10 percent), divorced or separated (10 percent) and widowed (18 percent). They were followed for a median of 76 months.

The research team found no statistically significant association between marital status and relapse-free survival. "Marital status alone wasn't significant as an independent predictor of outcome in terms of freedom from cancer," Hayes says.

Age, on the other hand, was found to be predictive of relapse-free survival, with women younger than age 40 doing worse than women over 70, despite similar tumor characteristics and treatment factors.

"Because marital status wasn't independently predictive of outcome while age was, maybe with younger women we need to be more aggressive in treating breast cancer," Hayes says.

There were, however, other differences corresponding to marital status. Women younger than 40 were more likely to be single, while women older than 70 were more likely to be divorced. Divorced women on the whole were younger than married women. Women who had been widowed were more likely to have tumors detected by mammography rather than a physical exam.

Two other studies, also from Fox Chase Cancer Center, addressed differences in breast cancer outcome based on treatment decisions.

One study found that the order in which tamoxifen and radiation are given following a lumpectomy for early stage breast cancer does not affect recurrence, survival or complication rates. Giving tamoxifen at the same time as radiation, however, has negative cosmetic results, the researchers says.

The second study found only a marginal benefit in giving an aromatase inhibitor drug to women with invasive breast cancer who have already undergone lumpectomy, radiation and five years of tamoxifen. Adding an aromatase inhibitor to this group of women, all of whom were disease-free after their treatment, would result in just a 1 percent to 2 percent clinical benefit.

Usually, a benefit level of 3 percent is needed before adding another therapy. Women with node-positive breast cancer along with women aged 60 or younger would be more likely to benefit from an aromatase inhibitor after an initial five years of tamoxifen, the researchers say.

(The HealthDay Web site is at http://www.HealthDay.com.)