Childhood social class and cancer incidence: Results of the globe study
Introduction
There is convincing evidence that socio-economic conditions at different stages of the life course influence adult health outcomes (Davey Smith and Lynch, 2004, Kuh and Ben-Shlomo, 2004, Kuh et al., 2003). Although investigations of early socio-economic origins of cardiovascular disease (CVD) have proceeded rapidly since the late 1980s (Galobardes, Smith, & Lynch, 2006), such investigations have only recently emerged for cancers (Frankel et al., 1998, Pensola and Martikainen, 2003, Potischman et al., 2004). These studies yielded contradictory results on the association between childhood socio-economic position (SEP) and cancer mortality; they were limited by using mortality as an outcome and did not investigate the association between cancer type and childhood SEP.
Previous studies indicate that SEP in adulthood is associated with cancer incidence and mortality rates, although associations vary by cancer type and geographic region (Faggiano et al., 1997, van Loon et al., 1995). For example, mainly in the western societies, people with a high SEP have an increased risk of melanoma, while those with a low SEP have an increased risk of lung cancer (Faggiano et al., 1997, van Loon et al., 1995). Several mechanisms have been proposed to explain these differences, including factors in childhood and adulthood. A higher prevalence of smoking, poor diet and physical inactivity in lower socio-economic groups seem to explain part of the socio-economic inequalities in lung cancer (Louwman et al., 2004, Lynch et al., 1997). Furthermore, higher exposure to infectious agents such as Helicobacter Pylori in childhood resulting from overcrowding may explain some of the impact of low SEP in childhood on stomach cancer (Davey Smith, Hart, Blane, & Hole, 1998).
Many years of epidemiological research into the aetiology of cancers have focused on host or environmental factors in adulthood. With much of cancer aetiology yet to be explained, new research incorporates earlier periods in life (Colditz and Frazier, 1995, Oliveria et al., 2006). An exposure acting during a specific time window could have long-lasting effects on the structure or the function of the body, resulting in the development of cancer. Alternatively, there could be cumulative effects of a set of independent risk factors over the life course that culminate in disease development in adulthood (Galobardes et al., 2004, Potischman et al., 2004). An increased emphasis on factors that act during childhood and adolescence, along with evaluations of the interplay among such factors, may improve our understanding of how early life exposures influence adulthood cancer risk.
This population-based study aimed to address: (1) Is there an association between childhood social class and cancer incidence? (2) Do adult educational level and occupational class influence cancer incidence? (3) To what extent is the association between childhood SEP and cancer incidence mediated by adulthood education and occupational class?
Section snippets
Materials and methods
The prospective GLOBE study started in 1991 with the aim to investigate the explanation of socio-economic inequalities in health. GLOBE is the Dutch acronym for ‘Health and Living Conditions of the Population of Eindhoven and Surroundings’. A detailed description of the purpose and design of the GLOBE study is presented elsewhere (Mackenbach, van de Mheen, & Stronks, 1994). At baseline, a sample of 27,020 non-institutionalised Dutch persons, between 15 and 74 years of age, living in or near the
Results
Between 1991 and 2005 a total of 1542 first tumours were diagnosed within the GLOBE population. The most frequent tumours were basal cell carcinoma (19.6% of all tumours), tumours of the breast (31.5% of all tumours among the female population), lung (12.3% of all tumours), colorectal (11.7% of all tumours) and prostate (16.1% of all tumours among the male population).
At baseline, respondents with lower SEP in childhood were more often male (52.8% versus 49.8%; P = 0.009), they were older (50.5
Discussion
A lower childhood SEP, as compared to the highest SEP in childhood, was associated with an increased risk of colorectal cancer and, although there was weaker evidence, with a reduced risk of basal cell carcinoma. Both associations remained significant after adjustment for respondent's educational level or adult social class. Childhood SEP was not associated with total cancer, lung, breast, and prostate cancers. Given associations between respondent's education and total cancer incidence, lung
Acknowledgement
The GLOBE study is performed by the Department of Public Health of Erasmus Medical Center Rotterdam, in collaboration with the Public Health Services of the city of Eindhoven and the region of Southeast Brabant. The GLOBE study was financially supported by The Netherlands Health and Development Council (ZON), the Ministry of Public Health, Welfare, and Sports, the Prevention Fund (‘Praeventiefonds’), and the Netherlands Organisation for the Advancement of Research (‘NWO’).
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