Educational Inequalities in Cancer Incidence in Turin, Italy

Spadea et al.
European Journal of Cancer Prevention 18(3) June 2009
ISSN: 0959-8278 • Frequency: 6/year • Impact Factor 1.865 • Subscribe Now

The objective of this study was to investigate the relationship between cancer incidence and socioeconomic status, and to examine the temporal trends in social inequalities in cancer risk. Educational differentials in the incidence of cancer (25 sites) among adult residents of Turin (Italy) were examined using data from the Turin Longitudinal Study and the Piedmont Cancer Registry. The relationship between cancer incidence and educational level was evaluated over three 5-year periods between 1985 and 1999 using Poisson models.

An estimated 17% of malignancies among men in the low-educational group was attributable to education, whereas women with a low educational level were slightly protected. Less-educated men had higher risks of upper aero-digestive tract, stomach, lung, liver, rectal, bladder, central nervous system and ill-defined cancers, and lower risks of melanoma, kidney and prostate cancers. Women with lower educational levels were at higher risk of stomach, liver and cervical cancers, whereas they were less likely to be diagnosed with melanoma, ovarian and breast cancers. For most sites, the educational gradient in risk did not vary substantially over time.
Educational inequalities in cancer risk observed in this dynamic Italian cohort, in general, appear similar in magnitude and direction to those found in other Western countries. The gradient in the risks observed for rectal, colon, kidney and uterine cancers differs, in part, from the results of other studies, and requires further investigation. The influence of educational level on cancer incidence seems to be greater among men, and an increase can be expected, given that many risk factors seem to be increasing among young people in lower social classes. This emphasizes the need to focus on measures for reducing social inequalities in these behavioural risk factors, especially during adolescence. The temporal changes in educational inequalities found for several sites suggest new hypotheses on the determinants, and on the role played by inequalities in access to early diagnosis (for kidney, breast, cervical and ill-defined cancers).

A thorough understanding of the relative burden of well-documented causes of social inequalities in cancer risk is essential to address preventive measures and to direct future research on unexplained social differences. This information can be partly obtained from studies conducted in other Western countries; however, a higher priority on surveillance studies of known lifestyle and biological risk factors for cancer in Italy is required, as a complete picture of the demographic, geographical and social pattern of these factors is still lacking. This knowledge would constitute the basis for predicting future trends in cancer risk and for designing and implementing suitable policies to tackle social inequalities.
 

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