Lower Risk of Melanoma Diagnosis and Increased Mortality Following Partner Bereavement

A study published in the British Journal of Dermatology observed a lower risk of melanoma diagnosis and increased mortality associated with partner bereavement.¹

Researchers indicated that these findings highlight the need to raise public awareness of the importance of self-skin examination, and to encourage clinicians to have a lower threshold for undertaking skin examinations in bereaved individuals. 

“The study findings are interesting and may relate to bereaved people no longer having someone to help with skin examinations, leading to delays in diagnosis, although we cannot rule out stress being important in melanoma progression,” senior author Sinéad Langan, PhD, of the London School of Hygiene and Tropical Medicine, said in a press release.² 

Two cohort studies were conducted using data from the UK Clinical Practice Research Datalink and Danish nationwide registries. In the first study, the researchers compared the risk of first melanoma diagnosis in bereaved people and matched nonbereaved people using stratified Cox regression. In the second study, researchers estimated hazard ratios (HRs) for death from melanoma in bereaved individuals compared with nonbereaved individuals with melanoma using Cox regression. They then estimated HRs separately for the two data groups and pooled the data to perform a random-effects meta-analysis. 

In the first study, the pooled adjusted HR for the association between partner bereavement and melanoma diagnosis was 0.88 (95% CI, 0.84-0.92) across the entire follow-up period. In the second study, researchers observed an increase in melanoma-specific mortality in people experiencing partner bereavement across the entire follow-up period (HR 1.17, 95% CI, 1.06-1.30), with the peak transpiring during the first year of follow-up (HR 1.31, 95% CI, 1.07-1.60). 

“Social isolation, residual socioeconomic confounding, reduced self-care, and reduced likelihood of seeking medical attention following bereavement may also have contributed to the lower incidence of diagnosed melanoma we observed,” the authors wrote. “Our study highlights the importance of encouraging family members or caregivers to perform skin examinations for bereaved persons.” 

Moreover, previous studies have suggested that stress hormones may accelerate growth and migration of tumor cells, which could worsen melanoma outcomes, as immunological surveillance is important in melanoma outcomes. Prior studies have also reported that a variety of positive psychosocial factors, such as marriage, predicted longer survival following melanoma. 

Notably, the authors did not have information on some risk factors for melanoma, including sun exposure, pigmentary traits, and family history of skin cancer. Misclassification of partnership also could have occurred, including changes in partner status over time. Specifically, in the UK, where direct data on partnership status was not available, a nondifferential misclassification and underestimation of any association may have occurred. 

According to the study, an estimated 197,000 news cases of melanoma are diagnosed globally each year. Further, in the UK and Denmark, new instances of melanoma account for 5-6% of all cancers, with approximately 16,000 cases diagnosed each year in the UK and 2,330 in Denmark.

References:

1. Wong AYS, Frøslev T, Dearing L, et al. The association between partner bereavement and melanoma: cohort studies in the U.K and Denmark. British Journal of Dermatology; 2020. doi:10.1111/bjd.18889.

2. Study Examines Potential Link Between Partner Bereavement and Skin Cancer [news release]. Published March 4, 2020. newsroom.wiley.com/press-release/british-journal-dermatology/study-examines-potential-link-between-partner-bereavement-. Accessed March 4, 2020.