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College-Educated Fare Better When Cancer Strikes

They've gained most from recent advances in treatment, survival, study finds

TUESDAY, July 8 (HealthDay News) - Recent U.S. declines in deaths from the four most common cancers -- lung, colorectal, prostate and breast -- are primarily benefiting better educated Americans, new research from the American Cancer Society shows.

While deaths from these malignancies did drop significantly from 1993 to 2001, most of that decline occurred among men and women with college degrees, the team found.

"Everybody has not been benefiting from advances in prevention and treatment of cancer," contends lead researcher Dr. Ahmedin Jemal, director of the Society's Cancer Occurrence Office.

"The decrease in cancer deaths is mostly confined to the most educated men and women," Jamal said. "For those less educated men and women, those rates are either stable or for some cancers has been increasing," he said.

The report was published July 8 in the online edition of the Journal of the National Cancer Institute.

In the study, Jemal's team collected data on cancer deaths between 1993 and 2001 from the U.S. National Center for Health Statistics.

The researchers found a significant drop in mortality from prostate, lung and colorectal cancer, for black and white men with 16 or more years of education (high school plus at least a 4-year college degree).

Death rates also declined among black and white women with 16 years of education or more for colorectal, breast and lung cancer. However, the drop in lung cancer death rates was not statistically significant among black women.

Among women with less than 12 years of education, only white women showed a significant decrease in deaths from breast cancer.

Over the same period, deaths from lung cancer among less educated white women actually increased, the study found. There was also a rise in deaths from colon cancer among less educated black men, Jamal's team found.

The probable reasons: "Less educated people have more risk factors for cancer like smoking and obesity," Jemal said. "They receive less medical services for prevention, early detection and treatment," he added. "Less access to care is a major barrier."

Jemal noted that education remains a strong marker for socioeconomic status. Less educated people tend to have less money and are less likely to seek medical attention for conditions that don't show immediate symptoms, he said.

"In addition, they are less likely to navigate the health care system effectively," Jemal said. "So, they are at a disadvantage."

To help the less educated to achieve the same benefits that better educated people have, Jemal believes there needs to be more emphasis placed on prevention and access to care.

Dr. Alfred I. Neugut, a professor of medicine and epidemiology at Columbia University College of Physicians and Surgeons and co-director of cancer prevention at NewYork-Presbyterian Hospital in New York City, said he wasn't surprised by the findings.

"The upper class in society always does better than the lower class," Neugut said. "Educational attainment in our society is a good marker of your social class," he said.

People who are bright do manage to get better care, Neugut believes. "They are better at taking advantage of what's learned by society in regard to health care," he said.

According to Neugut, it's interesting to note that when there is no treatment for a disease, there is usually no disparity in patient outcomes. "It's only when we develop an intervention that disparities appear," he said.

But there are also a variety of reasons that people don't take advantage of what health care has to offer, Neugut said. These include not knowing about new interventions, being afraid of them or doctors not offering them.

"The bottom line is that those in the lower part of society don't get equal care," Neugut said. "The disparities are not only because of lack of insurance. Even in Medicare, there are disparities based on socioeconomic status," he noted.

More information

For more about cancer, visit the American Cancer Society.

SOURCES: Ahmedin Jemal, D.V.M., Ph.D., director, Cancer Occurrence Office, American Cancer Society, Atlanta; Alfred I. Neugut, M.D., Ph.D., professor, medicine and epidemiology, Columbia University College of Physicians and Surgeons, co-director of cancer prevention, NewYork-Presbyterian Hospital, New York City; July 8, 2008, Journal of the National Cancer Institute, online issue

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