Education, Income and Risk of Cancer

[pjoshea13]

New Norwegian study below [1].

Consistent with numerous studies, education was seen as a risk factor for PCa.

I have always assumed that increased education would be associated with indoor work and less access to sunlight & natural vitamin D production. But how significant can that be in Norway? LOL (Oslo & Juneau have similar lattitudes.)

In this study, income was an even greater risk factor. (Income often comes with the downside of more responsibility & a greater number of hours at work (indoors).

Melanoma risk was even greater than PCa (for, both, education and income.) What use is education & income in Norway it you can't escape the climate & vacation somewhere dangerously hot each year? The irony of 50 weeks with no sunlight & 2 weeks with too much on that pale Nordic skin.

Incidentally, well-educated people are thought to have better diets. In pre-COVID days when I liked to dine out, I noticed that men in the more expensive restaurants were leaner on average than men eating in the cheaper restaurants. Indicating perhaps that income is associated with dietary restraint. In contrast, a great deal has been written about the "western diet" and its likely role in PCa.

Chart (a) in the full text, which lists cancers associated with education - lowest to highest - ranges from lung cancer at the top to melanoma at the bottom. The implication of the chart to me is that all but 4 of the 19 cancers have some kind of lifestyle factor component in their risk, related to education-income. (I still blame hours indoors for PCa risk.)

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/329...

cta Oncol

. 2020 Sep 14;1-8. doi: 10.1080/0284186X.2020.1817548. Online ahead of print.

Education, income and risk of cancer: results from a Norwegian registry-based study

Inger Kristin Larsen 1 , Tor Åge Myklebust 1 2 , Ronnie Babigumira 1 , Elina Vinberg 1 , Bjørn Møller 1 , Giske Ursin 1 3 4

Affiliations expand

PMID: 32924698 DOI: 10.1080/0284186X.2020.1817548

Abstract

Introduction: Several studies have shown an association between socioeconomic status and incidence of cancer. In this study, we have examined the association between socioeconomic factors, using income and education as proxies, and cancer incidence in Norway, a country known to be egalitarian, with universal access to health care and scoring high on the human development index.

Methods: We linked individual data for the total Norwegian population with information on all cancer patients registered in the Cancer Registry of Norway (CRN) with any cancer diagnosed between 2012 and 2016. Data on education, and individual income, were provided from Statistics Norway. We used Poisson regression to obtain incidence rate ratios (IRR) across education and income levels for 23 cancer sites.

Results: A total of 9 cancers among men and 13 cancers among women were observed to have significantly higher incidence rates in cases with the lowest level of education. Melanoma for both sexes, testis and prostate cancer in men, and breast cancer in women were found to have a higher incidence rate among those with the highest level of education. The largest differences in IRR were found for lung cancer, where men and women with college or university education as their highest completed education had a two- to threefold decreased risk, compared to those with primary school (IRR men; 0.40 [0.37-0.43], women 0.34 [0.31-0.37]). The results for income mirrored the results for education among men, while for women we did not observe many differences in cancer risk across income groups.

Conclusion: Our findings were consistent with findings from other studies showing that the incidence rate of cancer differs across levels of socioeconomic status. We may need behavioral change campaigns focused on lifestyle changes that lower the risk of cancer and target perhaps to those with lower socioeconomic status.

Keywords: Cancer incidence; SES; education; income.

[noahware]

As much as it may be true that money isn't the measure of a man, it quite often can be, in a man's OWN eyes. If we consider that in the modern West there is an association of higher social status with both higher income and higher education, we might then assume it is this higher social status (more than education and income themselves) that is inversely related to likelihood of clinically significant cancer.

Do those lower in the social hierarchy tend to have physiological differences (like lower serotonin levels) that might be more conducive to cancer progression, in general?

So many other factors, too. It is not just an increased likelihood of poorer diet or exercise habits with lower social status, but probably lesser amounts of quality sleep, greater likelihood of working 2nd and 3rd shift, more exposure to toxins and pollutants at work and home, more smoking and drinking (and sex and drugs and rock and roll!), less stimulation and satisfaction with career and social life, more dysfunctional relationships, less emotional stability/maturity, more time in front of a TV, etc. (gee, I think I'm describing myself here!).

In light of all that, it really starts to make sense to use some form of mindfulness, spirituality, religion or relaxation techniques -- as well as pursuing happy and healthy relationships -- as part of both prevention and treatment. It's not just the meds and foods and supplements and exercise that help keep cancer from killing.

[OR... if you can't be rich, and brilliant, at least be happy!]

[pjoshea13 in reply to noahware]

You wrote "at least be happy!"

Norway has been declared #1 in the world for happiness. The Norwegian study was presumably conducted on mostly happy people. LOL - at least prior to diagnosis.

Thomas Jefferson's phrase: "the pursuit of happiness" is an increasingly elusive goal when financial security is so precarious these days.

-Patrick

[noahware in reply to pjoshea13]

Money does not buy happiness... but I have found it CAN buy a reduced amount of worrying ABOUT money!

[rscic in reply to pjoshea13]

Denmark has also shown up in previous studies of happiness .... the Scandinavian countries figure prominently in these studies. These countries are more egalitarian (equal) than the USA .... also lower crime, higher taxes vs the USA (but with National Health Care paid for by taxes) and with greater trust of the government to do the "right thing". In Iceland, Ireland, New Zealand, Norway, the United Kingdom (Northern Ireland excepted) & Maldives, the police do not carry firearms unless the situation is expected to merit it. The Scandinavian countries of Iceland & Norway are on that list.

[rscic]

If I recall correctly, as affluence increases in a society so does animal product consumption and so do the diseases associated with the western world .... vascular disease & cancer among them. Affluence does not guarantee one will get these western diseases nor does lack of affluence while living in one of the few remaining more primitive areas of the world guarantee one will not get these but there are trends. There is the possibility that dietary differences due to income differences influence these trends.

[pjoshea13 in reply to rscic]

It is true that in China, affluence has affected the diet somewhat - more pork & less rice.

In the U.S. fast food chains offer meat products at affordable prices. I doubt that increasing income affects the amount of meat eaten very much. It might well affect the cut of meat. But the better, more expensive, restaurants in this part of the world do not cater to those who want a 16oz porterhouse. The exception is a relatively new Argentine restaurant, where servers circulate with platters of meats & you can eat as much as you want. It has always seemed anachronistic to me, when the trend amongst informed people is to limit red meat intake.

-Patrick

[rscic in reply to pjoshea13]

Eat vegan for 6 months with an eye on saving money (dried beans is often a staple) and you would find the costs are less and this would be significant if you had little money.

Even a small change in purchase decisions might have an influence ..... there is a lot we just do not know for certain. Animal products include meat & dairy. The income factor influences the diet of those who have money and those who do not at least on a world-wide basis (where the differences are admittedly greater) and might be a factor in the relationship between income & Prostate Cancer ...... or other health problems. It would not surprise me if this finding was more pronounced the greater the difference in diet/income.

There may be a totally different factor which is the cause of the relationship between income and Prostate Cancer but possible dietary differences has to be considered.

[noahware in reply to rscic]

"Eat vegan for 6 months with an eye on saving money "

This is where education and culture/advertising (especially) come into play in wealthier societies, because it seems that less educated folks will often save money on food by consuming the least expensive and more addictive of the LESS HEALTHY options, the mass-produced and highly processed renditions of white flour, white sugar, vegetable oil, factory-farmed meat/dairy, etc. rather than the more-healthy options like beans, carrots, yams, potatoes, etc.

It is true that globally, there is more consumption of animal-based and/or crappy processed foods in affluent societies than less affluent ones, but WITHIN the affluent societies it is the LESS affluent families/communities that tend towards more consumption of animal-based and/or crappy processed foods.

A store like Aldi has very inexpensive snack foods and breakfast cereals. In the US, pork and chicken products are often available at under $1 per pound at discount grocers. That is far cheaper than most fresh produce!

[pjoshea13 in reply to noahware]

& for poor people holding down 2 jobs, it's easier to pick up a cheap burger than to cook a meal.

-Patrick

[rscic in reply to noahware]

I agree there is some truth in what you say. However dried beans, a staple in some of the "Blue Zones" of increased longevity is an item of extreme low cost and shames $1 per pound meats. Back to the study. There are various factors (say for example stress) that could be reasons for the relationship between income and Prostate Cancer in this study. Dietary habits/necessities may be one of these and IMO should be considered ..... it may not be the reason but IMO should be considered as a possible reason. For example, the different types of meat and say their fat (or other) content might be a reason. With the variations in diet people might have, finding the reason for this income & Prostate Cancer relationship might be difficult to discover. I hope this is investigated further and a likely reason is found.

[noahware in reply to rscic]

Yes, beans are a great cheap food! I think there is cultural thing about them, at least in the US. Perhaps they were once (still?) associated with "being poor" and some families reject them as a staple on that basis, in spite of low cost and high healthfullness.

Or maybe it's just the farting.

[rscic in reply to noahware]

I think the poor association might be a valid one.

[pjoshea13 in reply to rscic]

Here is a 2019 paper:

"Preventable Cancer Burden Associated With Poor Diet in the United States"

Colon and rectum - 38,3%

Mouth, pharynx, and larynx - 25.9%

...

...

Prostate (advanced) - 0.92%

Thyroid - 0.88%

Interesting in that the top two are not associated with higher education & higher income, but the bottom two are.

academic.oup.com/jncics/art...

The two studies together suggest that diet-preventable cancers are associated with poorer education & lesser income.

& it suggests to me that many men with advanced PCa are looking at the wrong thing when they focus on diet, since, on average, we have little room for improvement.

-Patrick

[rscic in reply to pjoshea13]

You could be right but this factor needs to be eliminated ..... well, diet might have SOME influence but other factors might have more influence ..... correlation with the areas in the world with the lowest Prostate Cancer incidence might provide some clues.

QUESTIONS:

----Is this just a case of a "less bad" study?? How do the Prostate Cancer rates of the individuals in this study compare with the lowest incidences in the world?? If differences exist, what differences matter??

----Since testosterone influences most Prostate Cancer growth might lifetime high testosterone levels influence the incidence of Prostate Cancer??

----Is higher education correlated with higher testosterone levels??

----Does diet including calories consumed and components of diet influence testosterone levels or is this mostly genetic?? How might this relate to Education levels in the Norwegian study??

----Is higher education correlated with dietary changes?? If so what are these changes and do they have anything to do with Prostate Cancer??

----Do Eunuchs get Prostate Cancer?? If not why .... is it the testosterone or some other factor??

I used testosterone above in the questions as it might be a factor other than or along with. However, since as humans we are not likely to do away with testosterone, what are other factors??

It is my understanding that, by the age of 30 (at autopsy), around 50% of men have Prostatic Intraepithelial Neoplasia (PIN) -- a condition defined by neoplastic growth of epithelial cells within preexisting benign prostatic acini or ducts. PIN satisfies almost all the requirements for a premalignant condition, high-grade PIN (HGPIN) is widely accepted as a precursor to prostate cancer. By age 80 around 50% of men have Prostate Cancer (at autopsy). By age 30 is the die largely (on a population basis) already cast??

Your point on the article: "Preventable Cancer Burden Associated With Poor Diet in the United States" is a good one. However, as in most studies, comparisons are not (to my knowledge) made with the lowest incidences in the world & therefore could reflect how we might make Prostate Cancer less bad instead of reducing Prostate Cancer incidence optimally.

Right now researchers seem to have only a few pieces to a vast jigsaw puzzle. According to the 2019 study you referenced, diet might be a lesser factor .... it is a good argument but apparently (according to the 2019 study) diet does have some influence so what then are the other factors?? Would the influence of diet on Prostate Cancer in the 2019 study differ if compared with the lowest incidences in the world??

There is a lot which remains unknown.

Rick

[noahware in reply to rscic]

Actually, there seems to be more of a correlation of worse PC with lower T levels, not higher ones.

T and the androgen receptor are mediators of PC, but there is no indication that higher levels of T are either causal or indicative of aggressiveness/progression.

An interesting thing about that PIN or pre-cancer is that some populations (especially Asian) seem to have a much lower incidence of it developing into lethal PC. Is it diet, genetics, culture or some combination?

[rscic in reply to noahware]

A lot is not yet known. Eating a cancer prevention diet may help more (be more effective) with other cancers vs Prostate Cancers.

[noahware in reply to pjoshea13]

Or looked at another way, the modern Western diet IN GENERAL could be related to PC, and a little bit of tweaking here and there may not make as much of a difference in PC as with other cancers.

It seems likely that more affluent and better educated Westerners have "healthier" diets, but they are still prone to eat LOTS of protein-rich foods and LOTS of wheat-based carbs.

[rscic in reply to noahware]

I suspect cancers insensitive to testosterone may be less differentiated (more primitive cells) vs testosterone sensitive cancers. Alternatively, cancers insensitive to testosterone may be derived from different parts of the Prostate vs testosterone sensitive Prostate Cancers.

Just guesses on my part.

I would guess most diets have bad parts to them unless one designs them from the outset to produce for example low rates of Heart Disease.

[noahware in reply to rscic]

"as affluence increases in a society so does animal product consumption"

This is true of less affluent societies, that are getting wealthier. But as affluence increases in a society already at "peak-affluence" (as I would consider the US and many other Western economies) then I doubt animal product consumption would increase with the affluence of the wealthier individuals.

I think the US is particularly bad in this respect , though, due to government subsidies and factory farming that push prices of animal-based foods incredibly low, in historic (real) terms. Add to that the fast-food culture and relentless advertising and addictive nature of these foods, and you have a recipe (pun intended) for disaster!

[rscic in reply to noahware]

"Melanoma for both sexes, testis and prostate cancer in men, and breast cancer in women were found to have a higher incidence rate among those with the highest level of education."

So, correct me if I am wrong, by your reasoning those who have a poorer diet have less Prostate Cancer and so diet has no influence. Yet research suggests other cancers (some say Prostate Cancer is among these) seem to be influenced by diet.

Now you may be right and another factor/s may be at work in Prostate Cancer (including say maybe testosterone levels). However, since diet apparently influences other cancers, might diet, or at least a particular component of diet, influence Prostate Cancer incidence in this Norwegian study ..... researchers just do not know for sure.

IMO the other part to look at is comparing this Norwegian study vs the lowest Prostate Cancer incidences in the world. I expect there is a difference and if there is a difference then why?? Is this a case of Norwegian Prostate Cancer having a bad incidence and a particular portion of this population having a less bad but still bad incidence?? Now IMO we should still figure out why this particular segment of the population has a less bad incidence (if that is the case) but also IMO we do not want to miss the forest for the trees.

In this Norwegian study I expect Education is related to some other factor/s and this factor/s has yet to be discovered.

Just some thoughts on a part of the vast amount of knowledge researchers (let alone us) do not understand.

Rick

[noahware in reply to rscic]

Or... is it possible that prostate cancer is found to have a higher REPORTED incidence rate among those with the highest level of education because they are more likely to seek regular healthcare, and to be screened? Perhaps men w/ lesser education are also either more likely to die of other causes or die earlier, and die WITH their (undiagnosed) PC rather than die FROM it?

[pjoshea13 in reply to noahware]

Overscreening has been used to explain away the association between PCa & thyroid cancer diagnosis. Both were found more prevalent in Norwegian men with higher education/income.

Scandinavia did not take to the PSA test as enthusiastically as the U.S. did. The data was not adjusted for screening. It's a pity that advanced PCa was not treated as a separate category - being common in the unscreened. However, association of PCa with education was noted before the PSA era, when screening via DRE was hit or miss - mostly miss.

Norway is #6 in the world for PCa incidence (106.5 per age-standardized 100,000). The UK, where doctors in the NRS do not recommend PSA screening (but men may request it) stands at #16 (80.7).

Norway has among the highest prostate cancer mortality rates in the world (22.9 per 100,00). (21.5% of cases.) The U.S. death rate is ~19.0 per 100,000 men per year. The death rate in unscreened populations is ~35%.

So, overall, I'm guessing that PSA screening in Norway is fairly common these days. Even in men with lesser incomes.

-Patrick

[rscic in reply to noahware]

All are valid possibilities.

[dentaltwin]

I don't have access to the entire paper. Were the results corrected for obvious confounders, such as smoking, urban vs. rural, etc.?

[DonUSNA73]

AND, higher income may = less time outdoors in the sun (such as it is in Norway), less physically demanding jobs, more public transportation (walking & biking) to get to those jobs, and, as I think others have said above, fewer dietary animal products. I'm always surprised by the large number of responses to any post that is even remotely associated with diet. A lot of passionate guys!

Don

[Graham49]

Regarding diet in Norway; beef, tobacco, alcohol, milk, cheese and eggs are relatively expensive, whilst fish is relatively cheap. So the well off can more easily afford the products that some studies show have an adverse affect on cancer.