Cancer deaths higher among less educated in US

14 September, 2007

In the United States, less educated people are more than twice as likely to die from cancer as their better-educated counterparts.

A study of people between the ages 25 and 64 found that death from all cancers in 2001 was roughly double in black men, white men, and white women with 12 years or less of education, compared with those with more than 12 years in education.

The risk for less-educated black women was 1.43 times their better-educated peers.

According to the study, published in the online edition of the Journal of the National Cancer Institute, cancer deaths were “generally higher” in blacks compared with whites. But, it also said that education could be a more important factor in determining death risk than race.

The new findings add to a wide body of research on health care disparities on account of socio-economic status and income levels in the United States. Access to health care is one of the hottest topics of debate in the US.

The study report comes on the heels of a new advertising campaign by the American Cancer Society that promotes the “politically contentious policy of health care access to all citizens to thwart cancer deaths.”

Jessica Albano, lead author of the study and a scientist at the American Cancer Society, said a number of factors could influence the association between education level and cancer death rate, including access to medical care associated with lack of health insurance, the prevalence of exposure to important risk factors such as cigarette smoking and obesity, and the likelihood of utilizing cancer screening.

Black men with 12 years of education or less had a prostate cancer death rate of 10.5 per 100,000, compared with 4.8 for those with more schooling.
A similar pattern, but with a smaller difference, was seen for white men.

The second finding was that breast cancer death rates were higher in less-educated women. This is contrary to a long-standing trend, particularly in white women with more education, where breast cancer risk was often higher, perhaps owing to later child-bearing.

Specifically, the rates for black women were 37.0 per 100,000 for those with less schooling and 31.1 for those with more schooling, respectively, and for white women the rates were 25.2 and 18.6 per 100,000, respectively.

The relatively large difference between the educational groups “suggests that modifiable factors associated with lower levels of education may play an important role” in prostate cancer mortality, especially among black men, according to the researchers.

Dr Sholom Wacholder, of the National Cancer Institute, said in an accompanying editorial that though the study adds to the wealth of descriptive data on racial disparities in cancer mortality in the United States, it is unrealistic to conclude that educational attainment in some way contributes to the disparities between blacks and white.