International Journal of Epidemiology, Vol 28, 380-385, Copyright © 1999 by International Epidemiological Association
A Tavani, F Fioretti, S Franceschi, S Gallus, E Negri, M Montella, E Conti and C La Vecchia
BACKGROUND: Socioeconomic correlates of cancer of the large bowel differ in
various countries and calendar periods and may differ for the colon and
rectum. Thus, the relationship between education and social class and risk
of cancers of the colon and rectum was considered. METHODS: Combination of
two hospital-based case-control studies conducted in six Italian centres
between 1985 and 1996. Cases were 3533 patients aged < 79, with
histologically confirmed cancer of the colon (n = 2180) or rectum (n =
1353), and controls were 7062 patients admitted to hospital for a wide
spectrum of acute, non-neoplastic, non- digestive tract diseases. RESULTS:
Compared to individuals with < 7 years of education the multivariate
odds ratios (OR) of colon cancer for those with > or = 16 years were
2.45 (95% confidence interval [CI]: 1.87-3.23) in men and 1.29 (95% CI:
0.88-1.90) in women, with significant trends in risk. No significant
association emerged between education and risk of rectal cancer, with OR of
1.18 (95% CI: 0.83- 1.70) and 1.01 (95% CI: 0.61-1.67) respectively for men
and women in the highest educational category compared to the lowest.
Social class was also related to colon cancer risk: the OR were 2.30 (95%
CI: 1.82- 2.90) in men and 1.33 (95% CI: 1.03-1.73) in women in the highest
versus the lowest social class. No association was found between social
class and rectal cancer risk, with OR of 1.18 for either men or women in
the highest as compared to the lowest social class. No significant
heterogeneity was found for the association between education and colon
cancer risk in either sex across strata of age at diagnosis, coffee,
alcohol and vegetable intake, family history of the disease, and in
anatomical subsites within the colon. CONCLUSION: This study, based on a
uniquely large dataset, indicates that there are different social class
correlates for colon and rectal cancer. Consequently the two sites should
not be combined in studies considering lifestyle factors in the aetiology
of these neoplasms.
ARTICLES
Education, socioeconomic status and risk of cancer of the colon and rectum
Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. tavani@irfmn.mnegri.it
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