Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome

Aarts, Mieke J.; Lemmens, Valery; Louwman, Marieke W. J.; Kunst, Anton E.; Coebergh, Jan Willem

doi:10.1016/j.ejca.2010.04.026

Cited by 198 publications

(190 citation statements)

References 87 publications

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“…This inverse association was most pronounced in women and in Southern Europe. Our results are consistent with a recent systematic review, 12 which reported an association between an increased CRC incidence rate and higher SES among participants in Europe. People with lower SES have been shown to be more likely to present with a more advanced CRC stage compared to people with a higher SES.…”

Section: Discussionsupporting

confidence: 93%

Educational level and risk of colorectal cancer in EPIC with specific reference to tumor location

Leufkens

Duijnhoven

Boshuizen

et al. 2011

Intl Journal of Cancer

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Existing evidence is inconclusive on whether socioeconomic status (SES) and educational inequalities influence colorectal cancer (CRC) risk, and whether low or high SES/educational level is associated with developing CRC. The aim of our study was to investigate the relationship between educational level and CRC. We studied data from 400,510 participants in the EPIC (European Prospective Investigation into Cancer and Nutrition) study, of whom 2,447 developed CRC (colon: 1,551, rectum: 896, mean follow‐up 8.3 years). Cox proportional hazard regression analysis stratified by age, gender and center, and adjusted for potential confounders were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI). Relative indices of inequality (RII) for education were estimated using Cox regression models. We conducted separate analyses for tumor location, gender and geographical region. Compared with participants with college/university education, participants with vocational secondary education or less had a nonsignificantly lower risk of developing CRC. When further stratified for tumor location, adjusted risk estimates for the proximal colon were statistically significant for primary education or less (HR 0.73, 95%CI 0.57–0.94) and for vocational secondary education (HR 0.76, 95%CI 0.58–0.98). The inverse association between low education and CRC risk was particularly found in women and Southern Europe. These associations were statistically significant for CRC, for colon cancer and for proximal colon cancer. In conclusion, CRC risk, especially in the proximal colon, is lower in subjects with a lower educational level compared to those with a higher educational level. This association is most pronounced in women and Southern Europe.

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Section: Discussionsupporting

confidence: 93%

Educational level and risk of colorectal cancer in EPIC with specific reference to tumor location

Leufkens

Duijnhoven

Boshuizen

et al. 2011

Intl Journal of Cancer

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“…It should be recognized, however, that in specific indications such as muscle invasive bladder cancer, where surgery is indicated, radiotherapy could be the preferred option with increased utilization in the elderly with comorbidity [24]. À Third, comparable effects were seen from patient-related factors such as the lower socio-economic level [25]. À A fourth relevant aspect is the preference of the physician for one therapeutic option over alternatives.…”

Section: Discussionmentioning

confidence: 99%

The optimal utilization proportion of external beam radiotherapy in European countries: An ESTRO-HERO analysis

Borràs

Lievens

Dunscombe

et al. 2015

Radiotherapy and Oncology

144

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a b s t r a c tBackground and purpose: The absolute number of new cancer patients that will require at least one course of radiotherapy in each country of Europe was estimated. Material and methods: The incidence and relative frequency of cancer types from the year 2012 European Cancer Observatory estimates were used in combination with the population-based stage at diagnosis from five cancer registries. These data were applied to the decision trees of the evidence-based indications to calculate the Optimal Utilization Proportion (OUP) by tumour site. Results: In the minimum scenario, the OUP ranged from 47.0% in the Russian Federation to 53.2% in Belgium with no clear geographical pattern of the variability among countries. The impact of stage at diagnosis on the OUP by country was rather limited. Within the 24 countries where data on actual use of radiotherapy were available, a gap between optimal and actual use has been observed in most of the countries. Conclusions: The actual utilization of radiotherapy is significantly lower than the optimal use predicted from the evidence based estimates in the literature. This discrepancy poses a major challenge for policy makers when planning the resources at the national level to improve the provision in European countries.Ó 2015 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology xxx (2015) xxx-xxxThe estimated number of new cancer patients that require radiotherapy is a key parameter for planning the resources needed in a specific country in the framework of a cancer control programme. Most commonly, this calculation has been carried out using a specific proportion, typically the 'gold standard' of 50%, of the incident cases that would require radiotherapy at least http://dx

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“…The nature of the Genetic susceptibility of CRC in Latin America G Hernandez-Suarez et al Table 1 Main demographic characteristics and risk factors in the study population Genetic susceptibility of CRC in Latin America G Hernandez-Suarez et al association between SES and colorectal cancer risk is discrepant across continents. 31 Whilst studies in Europe, East Asia and Australia, in general, have found a positive association, in the United States and Canada the association observed is inverse. 31,32 This discrepancy is not fully understood but it is partially explained by differences in screening coverage 31 and the way environmental factors (mediators) are interrelated with SES (determinants).…”

Section: Discussionmentioning

confidence: 99%

“…31 Whilst studies in Europe, East Asia and Australia, in general, have found a positive association, in the United States and Canada the association observed is inverse. 31,32 This discrepancy is not fully understood but it is partially explained by differences in screening coverage 31 and the way environmental factors (mediators) are interrelated with SES (determinants). 32,33 Our results are contrary to a previous study reporting a positive association of colorectal cancer and SES in Colombia.…”

Section: Discussionmentioning

confidence: 99%

Genetic ancestry is associated with colorectal adenomas and adenocarcinomas in Latino populations

et al. 2014

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Colorectal cancer rates in Latin American countries are less than half of those observed in the United States. Latin Americans are the resultant of generations of an admixture of Native American, European, and African individuals. The potential role of genetic admixture in colorectal carcinogenesis has not been examined. We evaluate the association of genetic ancestry with colorectal neoplasms in 190 adenocarcinomas, 113 sporadic adenomas and 243 age-and sex-matched controls enrolled in a multicentric case-control study in Colombia. Individual ancestral genetic fractions were estimated using the STRUCTURE software, based on allele frequencies and assuming three distinct population origins. We used the Illumina Cancer Panel to genotype 1,421 sparse single-nucleotide polymorphisms (SNPs), and Northern and Western European ancestry, LWJ and Han Chinese in Beijing, China populations from the HapMap project as references. A total of 678 autosomal SNPs overlapped with the HapMap data set SNPs and were used for ancestry estimations. African mean ancestry fraction was higher in adenomas (0.13, 95% confidence interval (95% CI) ¼ 0.11-0.15) and cancer cases (0.14, 95% CI ¼ 0.12-0.16) compared with controls (0.11, 95% CI ¼ 0.10-0.12). Conditional logistic regression analysis, controlling for known risk factors, showed a positive association of African ancestry per 10% increase with both colorectal adenoma (odds ratio (OR) ¼ 1.12, 95% CI ¼ 0.97-1.30) and adenocarcinoma (OR ¼ 1.19, 95% CI ¼ 1.05-1.35). In conclusion, increased African ancestry (or variants linked to it) contributes to the increased susceptibility of colorectal cancer in admixed Latin American population.

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Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome

Cited by 198 publications

References 87 publications

Educational level and risk of colorectal cancer in EPIC with specific reference to tumor location

Educational level and risk of colorectal cancer in EPIC with specific reference to tumor location

The optimal utilization proportion of external beam radiotherapy in European countries: An ESTRO-HERO analysis

Genetic ancestry is associated with colorectal adenomas and adenocarcinomas in Latino populations

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