NEW YORK—The disadvantaged, once they have cancer, are then more likely to die from it, according to Prof. Harry Burns. "Poverty influences cancer in some quite unexpected ways," said Prof. Burns, director of public health, Greater Glasgow Health Board, Glasgow, Scotland. "The politicians, and all of us as voters, have a responsibility to think about this."
Speaking at a conference sponsored by Gilda’s Club International and Marie Curie Cancer Care, Prof. Burns drew upon medical research and social theory to suggest why poor persons living in deprived areas are more likely to get and die from cancer.
Scottish data show that there is an approximate 10% decrement in survival between affluent and deprived Glasgow residents across a whole range of common cancers, including breast cancer, colon cancer, non-Hodgkin’s lymphoma, and melanoma. Five-year survival in breast cancer is 58% and 48%, respectively, for the most affluent and most deprived Glaswegians.
Evidence that these higher cancer mortality rates in the poor are not just related to smoking, diet, and other lifestyle choices can be found in a comparison of four major cohort studies, he said.
The comparison shows that the average annual rate of death from lung cancer among individuals who smoke an average of 20 cigarettes per day is similar (around 100 per 100,000 individuals) for cohorts of US veterans, UK doctors, and American Cancer Society volunteers. By contrast, a cohort of smokers in the West of Scotland showed a risk of dying of lung cancer about 3.5 times higher.
A large part of that excess mortality was related to socioeconomic status: Lung cancer death rates were significantly higher among manual laborers who smoked, compared with nonmanual laborers who smoked the same number of cigarettes.
Likewise, breast cancer mortality appears related to socioeconomic status. The Scottish data show that while affluent women are more likely to have breast cancer, mortality rates are about the same across economic strata, suggesting that poorer women are more likely to die of breast cancer when they have it.
