Disparity in Cancer Diagnosis: Is It Someone Else's Problem?
Hello. I am David Kerr, Professor of Cancer Medicine at University of Oxford and past President of the European Society for Medical Oncology. Today I want to discuss a very interesting study presented by Dr. Lyratzopoulos and colleagues from the Institute of Public Health Research at Cambridge, looking at poverty and stage of diagnosis of cancer.
If we had one battle cry in cancer control, excluding prevention, it would be "stage, stage, stage." We know that the earlier the stage when we detect the cancer, the greater the chance of cure and the more opportunity to apply the modern medical techniques that we have at our fingertips as cancer specialists and physicians.
These researchers have, rather elegantly, taken their cancer registry in the east of England around the University of Cambridge and, using a well-validated technique, linked levels of poverty in the 88,000 individuals with cancer who were tracked during a period of about 5 years. They linked poverty to stage at presentation and found that the relatively poor, the socioeconomically deprived, were much more likely to present with advanced-stage cancer for melanoma, prostate, endometrial, and breast cancers. The hazard ratios varied from around 2.2 for melanoma to around 1.3 for breast cancer -- a large effect.
If we extrapolate their figures across all of England, and if we could wipe out this poverty-driven differential in stage at diagnosis, they estimate that another 6000 patients a year could be caught at earlier -- potentially curable -- stages.
These findings have implications for all of us who are involved in delivering cancer care and who are interested in improving policy. If we look across the world at a time when relatively little more money will be spent in healthcare, when we are trying to embrace value as a concept that guides us, and as Obamacare unfolds in the United States, perhaps we should be targeting our early preventive and early detection interventions toward those who are less well-off and are relatively poor. If we do so, the gain in terms of life-years benefited would be significantly greater.
This is an interesting and compelling study showing a very strong link between late stage of cancer at presentation and poverty, something we should be aware of and do something about collectively.
As always, thanks for listening.
Hello. I am David Kerr, Professor of Cancer Medicine at University of Oxford and past President of the European Society for Medical Oncology. Today I want to discuss a very interesting study presented by Dr. Lyratzopoulos and colleagues from the Institute of Public Health Research at Cambridge, looking at poverty and stage of diagnosis of cancer.
If we had one battle cry in cancer control, excluding prevention, it would be "stage, stage, stage." We know that the earlier the stage when we detect the cancer, the greater the chance of cure and the more opportunity to apply the modern medical techniques that we have at our fingertips as cancer specialists and physicians.
These researchers have, rather elegantly, taken their cancer registry in the east of England around the University of Cambridge and, using a well-validated technique, linked levels of poverty in the 88,000 individuals with cancer who were tracked during a period of about 5 years. They linked poverty to stage at presentation and found that the relatively poor, the socioeconomically deprived, were much more likely to present with advanced-stage cancer for melanoma, prostate, endometrial, and breast cancers. The hazard ratios varied from around 2.2 for melanoma to around 1.3 for breast cancer -- a large effect.
If we extrapolate their figures across all of England, and if we could wipe out this poverty-driven differential in stage at diagnosis, they estimate that another 6000 patients a year could be caught at earlier -- potentially curable -- stages.
These findings have implications for all of us who are involved in delivering cancer care and who are interested in improving policy. If we look across the world at a time when relatively little more money will be spent in healthcare, when we are trying to embrace value as a concept that guides us, and as Obamacare unfolds in the United States, perhaps we should be targeting our early preventive and early detection interventions toward those who are less well-off and are relatively poor. If we do so, the gain in terms of life-years benefited would be significantly greater.
This is an interesting and compelling study showing a very strong link between late stage of cancer at presentation and poverty, something we should be aware of and do something about collectively.
As always, thanks for listening.
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