When it Comes to Dying of Cancer, Education Matters

The American Cancer Society is out with its annual stats on how many people get and die from the disease in the U.S.

Incidence and death rates are on the decline, though this year, the report estimates, there will still be almost 1,597,000 new cases of cancer and 571,950 deaths.

But beyond the big-picture view, this year’s report digs into the disparities between the least- and most-educated. And they’re big. In 2007, cancer death rates for the least-educated were 2.6 times those of the most-educated. We asked one of the report’s authors, Ahmedin Jemal, ACS’s vice president of surveillance research, to help us understand why.

The number of years spent in school isn’t important because there’s some mandatory course for college freshmen that explains how to prevent cancer. Instead, it’s a proxy for socioeconomic status. Jemal tells the Health Blog that it’s a more permanent indicator than income or employment status, both of which can vary over a lifetime. And practically speaking, it’s available on death certificates, which is where the stats are drawn from.

Socioeconomic status affects cancer incidence and mortality in a bunch of different ways, he says. First, he says, the more-educated are much less likely to engage in high-risk behaviors such as smoking. “Knowledge matters,” he says. Indeed, 31% of men with 12 or fewer years of education are current smokers, vs. 12% of college grads and 5% of those with a graduate degree. And consequently, the lung-cancer death rate is five times higher in the least educated than in the most.

Obesity rates, too, are higher in people with lower socioeconomic status. People know less about nutrition. They have less access to affordable healthful foods. And it’s harder to get exercise — less access to safe running or biking areas near to home or to gyms.

People of lower socioeconomic status are also less likely to see a doctor regularly, particularly if they’re uninsured. “Having insurance is really everything in terms of access to care,” says Jemal. “They’re less likely to get preventive services, early detection and adequate treatment in a timely manner.”

Finally, he says illiteracy contributes to the disparities. People with low reading ability “are less likely to successfully navigate the health-care system and less likely to follow a doctor’s orders,” often because they don’t understand things like dosing instructions, he says.

The report discusses racial disparities, too. But underscoring the importance of socioeconomic status, it says that closing the gap between the most- and least-educated African-Americans could “potentially avert twice as many premature cancer deaths as eliminating racial disparities between blacks and whites.” Across the U.S., if death rates among the least-educated were the same as those among the most-educated, 60,370 premature deaths in 2007 amongst people aged 25-64 could have been prevented, the report estimates.