Killer with a BIAS

There is overwhelming evidence that some of the common cancers target the poor

Published: Wednesday 15 November 2000

Killer with a BIAS

cancer is not an 'equal opportunity killer'. Samuel Broder, director of the us National Cancer Institute, says, "Poverty is a carcinogen." That the living conditions of the industrial poor put them at a greater risk of several diseases has been known since the days of Charles Dickens' novels. Writing in the British Medical Journal in 1902, W J Sinclair, an obstetrician, remarked that cervical cancer was a disease occurring "almost exclusively among the poor, the chronically overworked and underfed, among women, poor, prolific, harassed, worried... reposeless." Since that time, numerous reports from different countries have confirmed that economically disadvantaged groups in society are at increased risk of cancer.

Among individual types of cancer associated most consistently with low socioeconomic status are cancers of the lung, cervix and stomach, observed Lorenzo Tomatis, former director of the International Agency for Research on Cancer ( iarc ) in Lyon, France, which is within the framework of the World Health Organisation. Tomatis' 1992 editorial in the journal Cancer Epidemiology, Biomarkers and Prevention drew attention to the relationship between poverty and cancer risk, not only in developing countries but also in industrialised countries, where higher cancer risks and lower socioeconomic class go hand in hand.

In an article that dealt with poor children being subjected to environmental injustice, the Journal of American Medical Association , in its June 21, 2000 issue, touched upon a subject that is severely neglected. Philip Landrigan, head of the department of community and preventive medicine at Mount Sinai School of Medicine in New York City, was quoted as saying that a number of toxins, such as lead, polychlorinated biphenyls ( pcb s) and organophosphate pesticides, are disproportionately concentrated in environments where disadvantaged children live. "As it turns out, many of the children who are most heavily exposed in our society to environmental toxins are the same children who are poor, the same children who have either no access or inadequate access to medical care," said Landrigan, who called this phenomenon 'environmental injustice'.

In cases where poverty is not necessarily associated with increased incidence of cancer, it has been shown repeatedly to be related to poorer survival rate. For example, a 1991 paper entitled 'Socioeconomic factors and cancer incidence among blacks and whites', published in the Journal of National Cancer Institute , showed that affluent women have a higher incidence of breast cancer. But a 1992 paper entitled 'Socioeconomic factors and race in breast cancer recurrence and survival', published in the American Journal of Epidemiology , showed that affluent women have better chances of survival from the disease as compared to poor women.

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