title: Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome.
abstract: BACKGROUND
  Upcoming mass screening for colorectal cancer (CRC) makes a review of recent literature on the association with socioeconomic status (SES) relevant, because of marked and contradictory associations with risk, treatment and outcome.
  
  
  METHODS
  The Pubmed database using the MeSH terms 'Neoplasms' or 'Colorectal Neoplasms' and 'Socioeconomic Factors' for articles added between 1995 and 1st October 2009 led to 62 articles.
  
  
  RESULTS
  Low SES groups exhibited a higher incidence compared with high SES groups in the US and Canada (range risk ratio (RR) 1.0-1.5), but mostly lower in Europe (RR 0.3-0.9). Treatment, survival and mortality all showed less favourable results for people with a lower socioeconomic status: Patients with a low SES received less often (neo)adjuvant therapy (RR ranging from 0.4 to 0.99), had worse survival rates (hazard ratio (HR) 1.3-1.8) and exhibited generally the highest mortality rates up to 1.6 for colon cancer in Europe and up to 3.1 for rectal cancer.
  
  
  CONCLUSIONS
  A quite consistent trend was observed favouring individuals with a high SES compared to those with a low SES that still remains in terms of treatment, survival and thus also mortality. We did not find evidence that the low/high SES gradients for treatment chosen and outcome are decreasing. To meet increasing inequalities in mortality from CRC in Europe for people with a low SES and to make mass screening successful, a high participation rate needs to be realised of low SES people in the soon starting screening program.
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), P.O. Box 231, 5600 AE Eindhoven, The Netherlands. research@ikz.nl
authors.forename: Mieke J
authors.initials: MJ
authors.lastname: Aarts
authors.forename: Valery E P P
authors.initials: VE
authors.lastname: Lemmens
authors.forename: Marieke W J
authors.initials: MW
authors.lastname: Louwman
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.forename: Jan Willem W
authors.initials: JW
authors.lastname: Coebergh
mesh_terms: D015179:Colorectal Neoplasms / Q000401:mortality* / Q000628:therapy; D014943:Global Health; D006801:Humans; D015994:Incidence; D011379:Prognosis; D012307:Risk Factors; D012923:Social Class