Work Package Leader: Anton Kunst

The incidence of many cancer sites strongly varies according to the socioeconomic position of people. However, the magnitude of socioeconomic differences in cancer incidence changes over time and varies according to country. Different behavioral factors contribute to these inequalities, as people with lower socioeconomic position generally smoke more cigarettes, more frequently drink excessively, and more often are overweight. Scenarios of the future incidence of cancer should therefore give particular attention to the developments among lower socioeconomic groups, and the potential gains that policies can achieve among these groups.

This work package aims to support the development of scenarios of cancer incidence among specific socio-economic group. The general purpose of this work package is to provide a European overview of socioeconomic inequalities in cancer incidence and outcome, and of inequalities in the prevalence of behavioral risk factors for cancer. Socioeconomic position is measured by means of educational level, occupational class, and measures of wealth. Information is used from different data sources, including cancer registers, national mortality registries, and health interview surveys.

The work package concentrated on three complementary topics.

1. Overviews of educational differences in cancer mortality.
2. In-depth studies of socioeconomic differences in cancer incidence.
3. Overviews of socioeconomic inequalities in specific risk factors for cancer incidence.

1. Overviews of educational differences in cancer mortality.
Data are used from national or local mortality registries with linkage to the population census, which are available for about 15 European countries. Principal researchers at the Erasmus MC are Gwenn Menvielle, Nicole Ezendam, and Anton Kunst. Four papers give:

• A general overview of inequalities in breast cancer mortality in 11 European populations;
  
• A comparison of inequalities in mortality between men and women in northern and southern European countries, for total cancer mortality and for the mortality from several cancer sites;
• An in-depth analysis of educational differences in cancers from the liver and the upper areo-digestive tract;
• An in-depth description of educational differences in cancer mortality in countries around the Baltic sea (Poland, Lithuania, Estonia, Sweden and Finland)
  These studies are carried out in cooperation with the EU Working Group of Socioeconomic Inequalities in health, with representatives from academic institutions and central statistical offices from nearly all EU member states.

2. In-depth studies of socioeconomic differences in cancer incidence.
This series of studies is carried out together with national teams from different countries. Each study addresses a specific topic of interest that can addressed only by the use of specialized data bases such as linkage of cancer registries to population censuses. Principal researchers at the Erasmus MC are Gwenn Menvielle, Heleen van Agt, and Anton Kunst. Three papers are envisaged that concentrate on:

• Comparison of different socioeconomic indicators (educational level, occupational class, housing characteristics, area-based measures) as predictors of cancer incidence in Turin, Italy. Local collaborators are Teresa Spadea and Nicolás Zengarini;
• Time trends in the incidence of specific cancer types according to occupational class between 1971 and 1995 in Finland, with emphasis on cohort patterns. Local collaborator: Eero Pukkala
• Educational differences in lung cancer incidence in 9 European countries included in the EPIC cohort study: the role of smoking, nutrition and other factors. Collaborator: Hendriek Boshuizen and Bas Bueno de Mesquita, on behalf of the EPIC lung cancer working group.

3. Overviews of socioeconomic inequalities in specific risk factors for cancer incidence.
These studies look at the prevalence of three behavioral risk factors for cancer incidence: smoking, alcohol abuse, and overweight. Each study utilizes data from interview surveys carried out at national or international levels. Principal researchers at the Erasmus MC are Maartje Schaap, Albert-Jan Roskam, and Anton Kunst. Three papers are being prepared that concentrate on:

• International overviews of socioeconomic differences in smoking prevalence. This paper will compare the predictive value of different socioeconomic indicators with regards to smoking in northern and southern Europe.
• International overviews of socioeconomic differences in the prevalence of overweight and obesity. This paper will compare the predictive value of different socioeconomic indicators for overweight in northern and southern Europe.
• An international overview of educational differences in the prevalence of alcohol abuse. The study will include measures of both alcohol consumption and binge drinking. Inequalities in these measures will be described for northern, southern and eastern regions of Europe.

Parts of the analyses under 3 will be done in cooperation with the EU Working Group of Socioeconomic Inequalities in health.

A report on the results of the EUROTHINE study, with related research topics, has already been published. The results of EUROTHINE will serve as a basis for some of the modelling done in Eurocadet. This report contains information on SES and alcohol consumption, smoking, smoking initiation, tobacco control programs, obesity, leisure time activity, and female cancer screening rates.

Results of this work package can be accessed through this link .

The end report of this work package can be found here.

 

People working on WP3 (in alphabetical order)

• Heleen van Agt (Erasmus MC)
• Hendriek Boshuizen (EPIC)
• Bas Bueno de Mesquita (EPIC)
• Nicole Ezendam (Erasmus MC)
• Gwenn Menvielle (Erasmus MC)
• Eero Pukkala (Finnish Cancer Registry) 
• Albert-Jan Roskam (Erasmus MC)
• Maartje Schaap (Erasmus MC)
• Theresa Spadea (Azienda Sanitaria Regionale, Turin)
• Nicolás Zengarini (Azienda Sanitaria Regionale, Turin)