Social inequalities
Socioeconomic factors and other social factors account for a large fraction of the total burden of cancer. Disadvantaged individuals and social groups have disproportionately high cancer mortality for most cancer types, compared with their fellow citizens. However, the existence of a social gradient across the population means that all individuals are affected by social inequalities. Social and socioeconomic inequalities may have a variable impact across countries, across specific cancer types, and along the cancer continuum, from the accumulation of risk factors to timely diagnosis, treatment, and survival.
Public health strategies typically focus on individual risk factors (e.g. tobacco smoking) and often overlook the role of the context as a driver of the observed socioeconomic inequalities in cancer. Also, although effective cancer control interventions exist, their overall effectiveness is limited by the failure to reach less advantaged population groups; this leads to a widening of the inequalities gap.
From the public health perspective, clarifying these issues may lead to a variety of possibilities for cancer control, reducing social inequalities in cancer, and informing the allocation of resources both within and outside the health system.
Description of the work
The aim of this work area is to measure and compare socioeconomic inequalities in cancer across countries, and to understand the reasons and mechanisms that underly these inequalities.
This programmatic area will benefit from the access to unique, high-quality datasets (e.g. GLOBOCAN, Cancer Incidence in Five Continents, Demetriq/Lifepath, the European Prospective Investigation into Cancer and Nutrition [EPIC], Lifepath, the Nordic Occupational Cancer Study [NOCCA]) and to a network of international partners that perform high-quality research. The work is organized around a set of major research projects (e.g. Descriptive epidemiology of social inequalities in cancer [SOCINEQ], the European Initiative to Better Understand Cancer [EU-UNCAN], the European Cancer Inequalities Registry, PERSONAE, STARTS) and includes the contribution to European Union projects, such as the European Cancer Inequalities Registry and UNCAN.
The specific objectives are:
a. Perform surveillance and measurement of cancer inequalities, including efforts to expand these activities in low- and middle-income countries;
b. Characterize the epidemiological features and impacts of social inequalities across several axes, including the stages of the cancer continuum, the phases of life, across countries and geographical regions, and across specific cancer types;
c. Understand the underlying mechanisms of these inequalities, from the structural determinants of health to other contextual factors and to individual determinants;
d. Quantify the potential for reducing socioeconomic inequalities in cancer, and the associated economic impact;
e. Clarify the role of potentially modifiable targets in reducing socioeconomic inequalities in cancer;
f. Identify the most efficient opportunities for action to reduce cancer inequalities;
g. Estimate the economic costs associated with social inequalities in cancer.
©IARC, Image credit Morena Sarzo
Educational inequalities in cancer mortality by cancer site and sex, in Europe
Team and collaborators
Principal Investigator: Salvatore Vaccarella, IARC
Deependra Singh, IARC
Marzieh Eslahi, IARC
Valentina Lorenzoni, IARC
Margherita Pizzato, IARC
Sébastien Lamy (Visiting Scientist), IARC
Damien Georges, IARC
Wilma Nusselder, Erasmus MC, The Netherlands
Paolo Vineis, Imperial College London, United Kingdom
Cyrille Delpierre, Inserm, France
Michael Marmot, University College London, United Kingdom
Sanna Heikkinen, National Cancer Center, Finland
Eero Pukkala, National Cancer Center, Finland
Hadrien Charvat, National Cancer Center, Japan
Esther De Vries, Pontificia Universidad Javeriana, Colombia
Péter Nagy, National Institute of Oncology, Hungary
Fulvio Ricceri, University of Turin, Italy
Carlotta Sacerdote, University of Turin, Italy
Selected publications
Youcef Ali M, Nusselder W, Weiderpass E, Corbex M, Bray F, Vaccarella S. (2023). Inequities in cancer outcomes. Bull World Health Organ. https://doi.org/10.2471/BLT.23.290661
Vaccarella S, Georges D, Bray F, Ginsburg O, Charvat H, Martikainen P, et al. (2022). Socioeconomic inequalities in cancer mortality between and within countries in Europe: a population-based study. Lancet Reg Health Eur. https://doi.org/10.1016/j.lanepe.2022.100551
Pizzato M, Martinsen JI, Heikkinen S, Vignat J, Lynge E, Sparén P, et al. (2022). Socioeconomic status and risk of lung cancer by histological subtype in the Nordic countries. Cancer Med. 11(8):1850–9. https://doi.org/10.1002/cam4.4548 PMID:35166068
Vaccarella S, Ginsburg O, Bray F (2021). Gender inequalities in cancer among young adults. Lancet Oncol. 22(2):166–7. https://doi.org/10.1016/S1470-2045(21)00001-2 PMID:33539738
Vaccarella S, Weiderpass E, Vineis P (2020). Present and future of health inequalities: rationale for investing in the biological capital. EClinicalMedicine. 19:100261. https://doi.org/10.1016/j.eclinm.2020.100261 PMID:32055791
Denny L, Jemal A, Schubauer-Berigan M, Islami F, Vilahur N, Fidler M, et al. (2019). Social inequalities in cancer risk factors and health-care access. In: Vaccarella S, Lortet-Tieulent J, Saracci R, Conway DI, Straif K, Wild CP, editors. Reducing social inequalities in cancer: evidence and priorities for research (IARC Scientific Publications No. 168). Lyon, France: International Agency for Research on Cancer; pp. 95–107. Available from: https://publications.iarc.fr/580.
Vaccarella S, De Vries E, Sierra MS, Conway DI, Mackenbach JP (2019). Social inequalities in cancer within countries. In: Vaccarella S, Lortet-Tieulent J, Saracci R, Conway DI, Straif K, Wild CP, editors. Reducing social inequalities in cancer: evidence and priorities for research (IARC Scientific Publications No. 168). Lyon, France: International Agency for Research on Cancer; pp. 63–78. Available from: https://publications.iarc.fr/580.
Vaccarella S, Lortet-Tieulent J, Saracci R, Fidler MM, Conway DI, Vilahur N, et al. (2018). Reducing social inequalities in cancer: setting priorities for research. CA Cancer J Clin. 68(5):324–6. https://doi.org/10.3322/caac.21463 PMID:30152865
Franceschi S, Plummer M, Clifford G, de Sanjose S, Bosch X, Herrero R, et al.; International Agency for Research on Cancer Multicentric Cervical Cancer Study Groups; International Agency for Research on Cancer Human Papillomavirus Prevalence Surveys Study Group (2009). Differences in the risk of cervical cancer and human papillomavirus infection by education level. Br J Cancer. 101(5):865–70. https://doi.org/10.1038/sj.bjc.6605224 PMID:19654578
Funding
Institut National du Cancer (INCa), France
European Initiative to Better Understand Cancer (EU-UNCAN)
European Cancer Inequalities Registry (EU-CanIneq)