ReviewSocioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome
Section snippets
Background
Socioeconomic inequalities in incidence and outcome have been reported for a variety of cancer types.1, 2, 3, 4, 5, 6 In general, cancer mortality is about 20–80% higher among individuals with a lower socioeconomic status (SES).7 This disadvantage may be the result of a higher cancer incidence in some countries and/or lower cancer survival rates in most of them. A comprehensive review of studies published up to 1995 revealed an opposite trend for colorectal cancer (CRC)7 – worldwide the third
Materials and methods
The electronic database of Pubmed was searched using the following strategy: (‘Neoplasms’[Majr:NoExp] or ‘Colorectal Neoplasms’[Mesh]) and (‘Socioeconomic Factors’[Mesh]). Only articles in English added to Pubmed between 1st January 1995 and 1st October 2009 were included. All types of studies focusing on incidence, (determinants of) treatment and outcome (i.e. survival and mortality) were included, except reviews. All patients with colon or rectal cancer were included, independent of their
Results
The Pubmed search yielded 1808 articles, which were scanned by title (resulting in 232 abstracts) and then by abstract (resulting in 120 full-text articles). Of these, 55 were included in this review. After scanning the reference lists, seven additional articles were included. Nineteen articles on incidence, 14 on survival, 20 on mortality and 14 on treatment were included; five studies concentrated on combinations of two of these, i.e. one on incidence and survival; one on incidence and
Discussion
A higher incidence of colorectal cancer was observed among low SES groups compared to high SES groups in the US and Canada, but not in Europe, where higher SES classes were at increased risk. Treatment, survival and mortality all showed less favourable results for people with a lower socioeconomic status: patients with a low SES had less chance of receiving (neo)adjuvant chemotherapy, had worse survival and mortality rates thus were highest in the lowest SES groups.
A high colon cancer incidence
Conflict of interest statement
None declared.
Acknowledgement
This work was supported by a grant from the Dutch Cancer Society 2006 (IKZ 2006-3588).
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