Social Environment and Cancer in Europe : Towards an Evidence-Based Public Health Policy

This contributed volume addresses the link between the social environment and cancer in Europe. The authors document the wide range and diverse trends in cancer incidence and patient survival in Europe, and they identify the main mechanisms and key influences that underlie these inequalities. They suggest a series of actions and programmes to tackle these inequalities in Europe, within the conceptual framework of intervention research. The influence of the social environment on the risk of suffering and dying from cancer is obviously a global phenomenon, as evidenced by a growing number of studies and books. In part, the underlying mechanisms are universal. Given the availability of a new standardised measure for social deprivation in Europe (the European Deprivation Index), the networking of population-based cancer registries across Europe as efficient surveillance tools, the increasing comparability of the organisation of care in European countries, and the recent launch of Europe’s Beating Cancer Plan, this extensive review of social inequalities in cancer on a European scale is both relevant and timely. The book consists of 21 chapters organised in four sections: Part I – General Considerations and Methodologic Aspects Part II – Social Disparities in Cancer Incidence and Survival – Reports Part III – Social Disparities in Cancer Incidence and Survival – Mechanisms Part IV – Towards an Evidence-Based Policy for Tackling Social Inequalities in Cancer Social Environment and Cancer in Europe: Towards an Evidence-Based Public Health Policy is a unique resource that presents up-to-date methods for analysing quantitative data. It focusses on inequalities in cancer incidence and survival within the wider framework of inequalities in health. This book will be an essential reference for policy-makers, researchers, public health professionals, social scientists and oncologists. Foreword Contents About the Editors Contributors Part I: General Considerations and Methodologic Aspects Chapter 1: Social Inequities in Cancer: Why Develop Scientific Research? References Chapter 2: Population-Based Cancer Registries: A Data Stream to Help Build an Evidence-Based Cancer Policy for Europe and for European Countries References Chapter 3: The European Deprivation Index: A Tool to Help Build an Evidence-Based Cancer Policy for Europe References Chapter 4: Social Disparities in Cancer Incidence: Methodological Considerations Introduction General Context Methodological Points Context of Spatial Analysis Bayesian Model for Smoothing Relative Risks Distribution of Hyperparameters σ2v and σ2u Regression Models with Covariates The Data The Results SIR, Smoothed SIR and Choice of Bayesian Model Regression Coefficients for the Explanatory Variables Sensitivity Analysis on the Choice of Hyper-Parameters Elements of Discussion Conclusion References Chapter 5: Social Disparities in Cancer Survival: Methodological Considerations Introduction Relative Survival Approaches Net Survival The Measure of Interest Estimation Age-Standardisation for Improving Comparability Measuring the Socioeconomic Deprivation Illustration – Part 1 Quantifying the Association between Socioeconomic Deprivation and Excess Mortality The Mortality Hazard Illustration – Part 2 Some Principles for Defining a Hazard-Based Regression Model Illustration – Part 3 Discussion References Part II: Social Disparities in Cancer Incidence and Survival — Reports Chapter 6: Social Disparities in Cancer Incidence Among Adults in Europe Background Cancers Associated with Low Socioeconomic Status Cancers Associated with High Socioeconomic Status Cancers Not Clearly Associated with Socioeconomic Status Conclusions References Chapter 7: Social Disparities in Survival from Breast Cancer in Europe Introduction Literature Review Patient and Tumour Characteristics Place of Birth and Age at Diagnosis Disease Stage at Diagnosis Cell Proliferation Rate and Molecular Markers Lifestyle and Comorbidity Factors Related to the Healthcare System Screening Treatment and Access to Care Factors Related to the Social Environment Familial Environment Social Relationships Comment Recommendations References Chapter 8: Social Disparities in Survival from Prostate Cancer in Europe Introduction Instruments Used in Europe to Measure SES in Prostate Cancer Survival with Prostate Cancer According to SES in Europe Conclusions References Chapter 9: Social Disparities in Survival from Lung Cancer in Europe Introduction Social Environment and Survival for Lung Cancer in European Countries The Studies Results Main Hypotheses for the Underlying Mechanisms Concluding Remarks References Chapter 10: Social Disparities in Survival from Head and Neck Cancers in Europe Introduction and Background Methodology Results Discussion Cancer Characteristics Patient Characteristics Social/Structural Characteristics Conclusion References Chapter 11: Disparities in Cancer Survival in Adults in Europe: The CONCORD Programme Introduction The CONCORD programme Results Other European Studies Discussion Conclusions References Part III: Social Disparities in Cancer Incidence and Survival — Mechanisms Chapter 12: Overview of Main Mechanisms Involved in Social Disparities in Cancer Incidence and Prognosis References Chapter 13: Behavioural Factors in the Social Gradients in Cancer Incidence Behavioural Factors Associated with Cancer Incidence Contribution of Behavioural Factors on Social Disparities in Cancer Incidence Socially Stratified Behavioural Risk Factors Quantification of the Cases Attributable to Behavioural Risk Factors in Social inequalities in Cancer Incidence Conclusion References Chapter 14: Occupational Factors in the Social Gradients in Cancer Incidence Cancers Related to Occupational Exposures Role of Occupational Exposures in Social Inequalities in Cancer Incidence Conclusion and Future Studies References Chapter 15: Environmental Determinants of the Social Gradient in Cancer Incidence Introduction Defining Environmental Determinants Environmental Determinants and Cancer Incidence: An Overview Air Pollution Radon Ultraviolet (UV) Radiation Water Contamination Neighbourhood Socioeconomic Environment Green Space Noise Measuring Environmental Determinants and Their Health Effects: Basic Principals and Challenges Mechanisms Connecting Environmental Determinants and the Social Gradient in Cancer Differential Exposure Differential Susceptibility Conclusion References Chapter 16: Life Course Approach, Embodiment and Cancer Social Inequalities in Health and Embodiment Embodiment and Allostatic Load Social Determinants and Allostatic Load Allostatic Load and Health Status Embodiment, Allostatic Load and Cancer A Promising Approach for Cancer Aetiology, but with Important Issues to Address Conclusion References Chapter 17: Role of Screening in the Social Gradient for Survival of Cancer Patients in Europe European Cancer Statistics and Recommendations Screening Organisation in European Countries Breast Cancer Screening Colorectal Cancer Screening Disparities in Screening Programmes in European Countries Impact of Inequalities in Participation More Equity Is Needed in Population-Based Screening Programmes Conclusion References Chapter 18: The Role of Comorbidities in the Social Gradient in Cancer Survival in Europe Defining Comorbidity Social Gradient in Comorbidity Prevalence Comorbidity Prevalence among Cancer Patients in Europe Role of Comorbidity as a Prognostic Factor in Cancer Outcomes Comorbidity May Influence Stage at Diagnosis Comorbidity May Influence Cancer Management and Therapeutic Options Clinical Management of Comorbidities with Cancer Among European Countries Comorbidity and Cancer Survival in Europe Comorbidity and Survival Comorbidity and Social Inequalities in Survival in Europe Proposing the Need for Life Tables by Deprivation Conclusions References Chapter 19: Geographical Remoteness and Cancer Survival in Europe Introduction Measuring Accessibility to Health Care Influence of Healthcare Accessibility on Cancer Management Cancer Screening, Stage at Diagnosis Access to Facilities Providing Cancer Care Influence of Accessibility to Health Facilities on Cancer Survival Conclusion References Part IV: Towards an Evidence-Based Policy for Tackling Social Inequalities in Cancer Chapter 20: Links Between Research in Public Health and Public Health Policy: The Conceptual Framework of Interventional Research Social Inequalities in Health Population Health Intervention Research Definition Characteristics Interdisciplinarity Researcher–Practitioner Partnership Empowerment Context Evaluation Example Conclusions References Chapter 21: Social Inequalities in Cancer: The Policies of the European Commission Introduction Social Inequalities and their Dimensions and Impact Across the Cancer Trajectory European Actions in the Field of Inequalities in Cancer Current and Potential EU Activities in the Field of Health Inequalities in Cancer Areas with the Most Immediate Need of Action at the European Level Conclusions References Index