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Annals of Oncology Advance Access published online on September 4, 2007
Annals of Oncology, doi:10.1093/annonc/mdm413
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© 2007 European Society for Medical Oncology

Influence of education level on cancer survival in Sweden

SK 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.

cancer, education, survival

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


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