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Annals of Oncology Advance Access originally published online on September 4, 2007
Annals of Oncology 2008 19(1):156-162; doi:10.1093/annonc/mdm413
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© 2007 European Society for Medical Oncology. For Permissions, please email: journals.permissions@oxfordjournals.org

epidemiology

Influence of education level on cancer survival in Sweden

S. K. Hussain1,*, P. Lenner2, J. Sundquist1 and K. Hemminki1,3

1 Center for Family and Community Medicine, Karolinska Institute, Huddinge
2 Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
3 Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany

* Correspondence to: Dr S. K. Hussain, Center for Family and Community Medicine, Karolinska Institute, Alfred Nobels allé 12, SE-141 83 Huddinge, Sweden. Tel: +46-8-524-886-68; Fax: +46-8-524-887-06; E-mail: shehnaz.hussain{at}ki.se

Background: While cancer survival at several sites has historically been shown to vary by education level, a current comprehensive assessment of survival following a cancer diagnosis in Sweden, a country with universal health care and cancer screening, has yet to be carried out.

Methods: Using the 2006 update of the Swedish Family-Cancer Database and Cox's proportional hazards regression methods, we calculate the adjusted hazard ratio (HR) and 95% confidence interval to estimate the influence of education level on site-specific cancer survival.

Results: Significant positive associations between education level and cancer survival were observed following a diagnosis of upper aerodigestive track cancer, colon cancer, pancreatic cancer, lung cancer, kidney cancer, urinary bladder cancer, melanoma, non-Hodgkin's lymphoma, breast cancer, endometrial cancer, cervical cancer, prostate cancer, and testicular cancer. Although the HRs differed between cancer sites, compared with women and men completing <9 years of education, university graduates were associated with a significant 40% improved survival for all cancer sites combined.

Conclusions: Survival differences by education level were observed for both indolent and aggressive malignancies.

Key words: cancer, education, survival

Received for publication April 19, 2007. Revision received July 15, 2007. Accepted for publication July 16, 2007.


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