Correlation of educational status and clinicopathological characteristics of breast cancer: a single center experience.
OBJECTIVE
Educational status may be an important parameter in assessing breast cancer risk and prognosis. The purpose of this study was to investigate the correlation between the level of education and clinicopathological characteristics of breast cancer, including tumor grade, HER-2 and estrogen receptor (ER) status, tumor size, axillary lymph node involvement and metastasis.


METHODS
The study included 1800 women who were diagnosed with invasive breast cancer during 2005-2013 at Hacettepe University Cancer Institute. Patients were divided into three groups according to their educational status at the time of diagnosis as follows: low (illiterate and elementary school, 5 years or less of education), medium (secondary school and upper secondary school, 6-12 years of education) and high (university level, more than 12 years of education). The associations between educational status and clinicopathologic features of breast cancer at the time of diagnosis were evaluated.


RESULTS
In all patient, a significant relationship was found between educational status and T stages (p<0.0001). Patients with higher educational levels were reported to have smaller tumor size regardless to their age and were less likely to have axillary lymph node involvement (p=0.001) or metastasis (p=0.001). A significant correlation was found between educational status and ER positivity in patients over 50 years of age (p=0.03). When the patients of all ages were evaluated, no statistically significant correlation was shown (p=0.27) between educational status and ER positivity. A significant relationship was found between educational status and HER-2 status (p=0.003), regardless of the patients' age. HER-2 positivity increased in patients with low educational status, however this significance was lost in patients over the age of 50 (p=0.1).


CONCLUSIONS
The relationship between educational status and biological factors in breast cancer are not conclusive as yet, but this particular study revealed that educational status played a major influence in each of the five breast cancer prognostic factors: ER status, HER-2 status, tumor size, lymph node status and metastasis.
Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey.
Furkan
F
Sarici
Taner
T
Babacan
Hakan
H
Buyukhatipoglu
Ozan
O
Balakan
Ali R
AR
Sever
Neyran
N
Kertmen
Ozan
O
Unlu
Ozturk
O
Ates
Omer
O
Diker
Serkan
S
Akin
Veli
V
Sunar
Yusuf
Y
Karakas
Sahin
S
Lacin
Kadri
K
Altundag
D001943:Breast Neoplasms / Q000209:etiology* / Q000378:metabolism / Q000473:pathology*; D004522:Educational Status; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D012306:Risk
D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen