Lower education linked to premature death from malignant melanoma

Cutaneous malignant melanoma is the most aggressive form of skin cancer, and one of the most rapidly increasing cancers among western populations. In response to this worsening health problem a team of researchers, led from Karolinska Institutet and Linköping University in Sweden, have accessed unique data from the Swedish Melanoma Register for examining the link between prognosis and socio-economic status in a large population-based study more closely.

Skin melanoma can be cured if the tumour is removed before the cancer cells have had time to spread to other parts of the body. The long-term survival rate for early-detected thin skin melanoma in Sweden is over 90 per cent. However, the prognosis for patients whose melanoma has already spread at the time of discovery is much worse. Early detection is therefore essential to a good prognosis.

The present study is based on all cases of invasive cutaneous malignant melanoma diagnosed in Sweden between 1990 and 2007. The researchers studied the survival statistics for over 27,000 melanoma patients relative to the point at which they left formal education (basic school, upper secondary, or tertiary), controlling for factors already known to affect prognosis (e.g. tumour properties, sex of patient and location of tumour).

"Our results show that patients diagnosed with cutaneous melanoma with a lower level of formal education have a more advanced disease at the time of diagnosis and thus a lower chance of survival," says Dr Hanna Eriksson, doctoral student at Karolinska Institutet's Department of Oncology-Pathology and lead author of the paper in which the results are presented. "Survival rates can be improved if we can reach these people with preventive measures so that the melanoma can be detected in time."

The researchers write that apart from the fact that people with a lower level of education tended to have later-stage melanoma when diagnosed, lifestyle factors and differences in access to healthcare may impact on this correlation between education level and prognosis.

"The relative effect of educational level on the risk of death from the disease was greater for example the women and younger individuals we looked at," says Dr Eriksson. "All in all, however, the men had worse prognoses than the women."

While previous research has shown that high socioeconomic status increases the risk of developing malignant skin melanoma, the present study indicates that a lower level of formal education is linked to a reduced survival from the disease in Sweden, where the aim of the healthcare services is to reach to the entire population.

The study was conducted by researchers from Karolinska Institutet and colleagues at the universities in Linköping, Lund, Uppsala, and Umeå, as well as the Skåne, Sahlgrenska, Linköping, and Karolinska university hospitals. It was financed by grants from the Swedish Cancer Society, the Cancer Research Funds of Radiumhemmet, the Sigurd and Elsa Golje Memorial Fund and the Stockholm County Council.