PURPOSE Lower socioeconomic status is associated with inferior cancer survival in high-income countries, but whether this applies to low- and middle-income countries is not well described. Here, we use a population-based cancer registry to explore the association between educational level and stage of cancer at diagnosis in South India. METHODS We used the Trivandrum District population-based cancer registry to identify all cases of breast and cervical cancer (women) and oral cavity (OC) and lung cancer (men) who were diagnosed from 2012 to 2014. Educational status—classified as illiterate/primary school, middle school, or secondary school or higher—was the primary exposure of interest. Primary outcome was the proportion of patients with advanced stage disease at diagnosis defined as stage III and IV (breast, cervix, or OC) or regional/metastatic (lung). RESULTS The study population included 4,547 patients with breast (n = 2,283), cervix (n = 481), OC (n = 797), and lung (n = 986) cancer. Educational status was 22%, 19%, and 26% for illiterate/primary, middle, and secondary school or higher, respectively. Educational status was missing for 33% of patients. The proportion of all patients with advanced stage disease was 37% (breast), 39% (cervix), 67% (OC), and 88% (lung). Patients with illiterate/primary school educational status were considerably more likely to have advanced breast cancer (50% v 39% v 36%; P < .001), cervix cancer (46% v 43% v 24%; P = .002), and OC cancer (77% v 76% v 59%; P < .001) compared with patients with higher educational levels. The proportion of patients with advanced lung cancer did not vary across educational levels (89% v 84% v 88%; P = .350). CONCLUSION A substantial proportion of patients in South India have advanced cancer at the time of diagnosis. This is particularly true among those with the lowest levels of education. Future health awareness and preventive interventions must target less-educated communities to reduce delays in seeking medical care for cancer.

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Introduction: Breast cancer is a leading cause of morbidity among women all around the world. Monitoring the survival pattern and identifying the prognostic factors on survival are always great concerns in cancer researches. Cure rate regression model is a useful statistical tool to predict the cure rate of cancer diseases and to determine the factors associated with survival of patients. Aim: The current study aimed to estimate the cured proportion and to make out the factors associated with survival time of infiltrating ductal breast carcinoma patients in a tertiary care hospital of central Kerala. Materials and Methods: The retrospective cohort study was conducted in the Department of Radiotherapy of a major tertiary care hospital of central part of Kerala, India. A total of 313 female patients diagnosed with infiltrating ductal breast cancer during January 2012 to December 2015 were considered for the study. The impact of the covariates, age at diagnosis of disease, grade of cancer, stage of disease, tumour stage, status of regional lymph node, distant metastasis, and triple negative status on survival of patients were studied. The parametric mixture cure rate regression model was used for estimation and inferential procedures. The cure rate with respect to each study variable and their role on long term survival of patients were investigated. Results: Mean age of patients was 51.95±10.91 years. The minimum cure rate found out (29.8%) among the patients presented with distant metastasis. The bivariate analysis showed the factors, stage of cancer, (T-stage), status of regional lymph node and distant metastasis status influence significantly on incidence of death due to breast cancer in long run period and grade of cancer determines the survival of patients at shorter duration of time. The presence of regional lymph node and distant metastasis status were found out to be two important indicators that determine cure rate of infiltrating ductal breast cancer patients in multivariate analysis. The hazard of patients living with higher grade cancer was seen 1.48 times more than that of others (Hazard Ratio=1.48, p-value <0.001). Conclusion: The cure rate of patients estimated between 29.8% and 69.6% with respect to various factors under study. The status of regional lymph node and distant metastasis status were found to be associated with cure rate of patients. The study results showed that the grade of cancer is one significant factor that determines survival of patients. The study recommends cure rate regression model as a useful tool to analyse breast cancer survival data in the presence of cured proportion.