The Socio-Economic Geography of Cancer

Being poor can affect the type of cancer you get.

A close up of cancer cells in the cervix.
National Journal
John Metcalfe, City Lab
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John Metcalfe, City Lab
May 27, 2014, 6:51 a.m.

We know that be­ing poor can make you sick. New re­search provides more evid­ence of this dis­mal link spe­cific­ally for can­cer: Liv­ing in poverty, it seems, is as­so­ci­ated with a high­er risk of con­tract­ing the kind of tu­mors that will kill you.

That’s the con­clu­sion of sci­ent­ists who’ve in­vest­ig­ated al­most 3 mil­lion ma­lig­nant tu­mors dia­gnosed in 16 states as well as the Los Angeles area — what they as­sert is the “most com­pre­hens­ive as­sess­ment of the re­la­tion­ship between SES (so­cioeco­nom­ic status) and can­cer in­cid­ence for the United States.” Over­all, they found no cor­rel­a­tion between how poor or rich you are and how likely you are to get can­cer. But drilling down in­to the census tracts with high­er poverty rates, they no­ticed a pre­val­ence of can­cers with low in­cid­ence and high mor­tal­ity rates. Wealth­i­er neigh­bor­hoods were marked by can­cers of high in­cid­ence, but low mor­tal­ity rates. As the lead re­search­er, Fran­cis Bos­coe at the New York State Can­cer Re­gistry, ex­plains: “When it comes to can­cer, the poor are more likely to die of the dis­ease while the af­flu­ent are more likely to die with the dis­ease.”

Out of 39 types of can­cer, 14 showed a pos­it­ive as­so­ci­ation with poverty, the re­search­ers said in their study (which was partly sup­por­ted by the Cen­ters for Dis­ease Con­trol and Pre­ven­tion). Poor neigh­bor­hoods were more likely to see can­cers of the larynx, cer­vix, liv­er, and penis, as well as Ka­posi sar­coma. They were also tied to an up­tick in can­cers re­lated to to­bacco use and hu­man papil­lo­mavir­us. Rich­er areas, mean­while, suffered more from melan­oma and oth­er skin af­flic­tions, and can­cers of the thyroid and testes.

What’s to ac­count for these dif­fer­ences? Though race might play a part in the grand scheme of can­cer, it’s not ap­plic­able to what the re­search­ers meas­ured in this ex­per­i­ment. “The SES ef­fects we re­port are in­de­pend­ent of race, as race was ad­jus­ted for in the ana­lys­is,” they say. Rather, there could be be­ha­vi­or­al and eco­nom­ic things at play here, such as sub­stance use and ac­cess to med­ic­al care, ac­cord­ing to the study:

In gen­er­al, can­cer sites as­so­ci­ated with be­ha­vi­or­al risk factors such as to­bacco, al­co­hol and in­tra­ven­ous drug use, sexu­al trans­mis­sion, and poor diet tend to be as­so­ci­ated with high­er poverty. In con­trast, can­cer sites as­so­ci­ated with over­dia­gnos­is are as­so­ci­ated with lower poverty, not­ably skin, thyroid, and pro­state. Over­dia­gnos­is refers to the clin­ic­al de­tec­tion of asymp­to­mat­ic tu­mors, of­ten through ad­vanced med­ic­al tech­no­logy, that would oth­er­wise re­main un­detec­ted and un­coun­ted.

For a break­down of the can­cers that are dia­gnosed in poor and rich neigh­bor­hoods, have a look at this graph the re­search­ers made for four poverty levels us­ing data from the 2005-2009 Amer­ic­an Com­munity Sur­vey. The af­flic­tions that strike in high­er-poverty areas are loc­ated to­ward the right, and can­cers dis­covered more in rich­er ‘hoods are shown to­ward left:

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