Higher education levels were strongly associated with decreased cancer mortality

A new American Cancer Society study finds having at least some education beyond high school is associated with a decreased risk of cancer death.

The study finds higher education levels were strongly associated with decreased cancer mortality among black men, white men, and white women. The difference in mortality for all groups was greatest between those with 12 or fewer years of education and those with more than 12 years.

Previous studies have found that death rates are higher among people with less education, but the current study is the first to analyze mortality by race/ethnicity, and is the first to look at the four major causes of cancer death. Led by Jessica Albano, MPH, Society researchers found that death rates for all cancers combined as well as for lung, colorectal, breast, and prostate cancers were strongly associated with years of education in white men, black men, and white women.

For all cancer sites combined, death rates among white and black men with the lowest (0-8 years) level of education were about three times higher than those with the highest (17+ years) level of education. At every level of education, death rates were higher for black than white men. Relationships between level of education and cancer death rates were weaker for women than for men, and also weaker for black women compared to white women. Nonetheless, cancer death rates were significantly higher among black women with 12 or fewer years of education compared to those with more education.

Several findings of the study were new and notable. A very strong relationship between years of education and prostate cancer was found for black men. Although level of education was strongly associated with prostate cancer mortality in both black and white men, at each level of education death rates for black men were substantially higher than those for white men. Also, the study for the first time found white women with higher levels of education had lower breast cancer death rates than those with less education, reversing the historical pattern that more-educated women were more likely to develop and die of breast cancer because of delayed childbirth and other reproductive risk factors. This change may reflect in part the increasing importance of early detection and timely and appropriate treatment in preventing deaths from breast cancer.

“Our study shows socioeconomic factors, as measured by years of education, play an important role in the risk of dying of cancer,” said Elizabeth Ward, Ph.D., American Cancer Society director of surveillance research and study co-author. “The relationships between socioeconomic status and race are complex and the strengths of the relationships we see depend in large part on what is measured in particular studies. Although this study measured differences in cancer mortality by individual level of education and race, the observed disparities likely result from multiple factors that influence health and health care at the individual, community and national level. Differences in cancer mortality by level of education should continue to be measured and used to track progress as we work to eliminate health disparities.”

The study adds to the body of evidence that cancer disparities result from by social and economic factors that are, at least in principle, preventable. The authors say these differences likely reflect relationships between education and other factors that are more directly associated with risks of developing and dying from cancer, such as tobacco use, cancer screening and access to timely and appropriate healthcare. Higher cancer mortality among blacks compared to whites at similar levels of education likely reflect differences in educational and employment opportunities, income, housing, overall standard of living, and access to medical care that are not fully captured by the single measure of socioeconomic status (i.e. years of education) available for their analysis.