LOW EDUCATIONAL LEVEL IS ASSOCIATED WITH ADVANCED CANCER STAGE IN BRAZIL

Ribeiro, Karina

INTRODUCTION:

Advanced stage at presentation is an important reason for poor cancer survival.This study was designed to investigate the association between education and cancer stage.

METHODS:

A descriptive epidemiological study was conducted, using data of adults with cancer (>19 years) from hospital-based cancer registries in the state of São Paulo for the period 2000-2010. Cancer staging was based on TNM system and grouped into 2 categories: early (stages 0, I, and II) and advanced stage (stages III and IV). Educational level was classified into 3 groups: illiterate or incomplete primary school, complete primary school, and ≥ complete high-school. Chi-square test was used to test association between education and stage. Odds ratios and corresponding 95% confidence intervals were calculated.

RESULTS:

407948 cases were registered. There was an equal distribution of cases according to sex (49.8% and 50.2% males and females, respectively). The majority of the cases were diagnosed in early stages (62.6%), with an improvement over the years (2000=57.7%; 2010=63.1%) and most of individuals had low educational level (59.4%). Highly educated patients presented lower percentage of cancers in advanced stage (p<0.001). Less educated women presented a higher risk of being diagnosed with advanced breast cancer compared to those with better education (OR=1.69, 95% CI 1.60-1.78). Similar findings were observed for several cancer types, including: lung (males: OR=1.57, 95% CI 1.34-1.83; females: OR=1.54, 95% CI 1.25-1.90), prostate (OR=1.68, 95% CI 1.57-1.80), oral/oropharyngeal (males: OR=1.28, 95% CI 1.12-1.45; females: OR=1.42, 95% CI 1.08-1.85).

CONCLUSIONS:

In our study, low educational level was significantly associated with advanced cancer stage. This association can be related not only to differences in cancer awareness but also to different patterns of referral and navigation in the healthcare system, requiring the planning of optimized referral networks to decrease these disparities.