ABC of colorectal cancer: Epidemiology

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Abstract
Survival and deprivation The relation between poverty and ill health has been researched for more than 100 years. In Scotland, since the 1851 census, all cause occupational mortality has been routinely reported, and since 1911, inequalities in health, as shown by mortality, have been examined in decennial reports classified by social class (based on occupation) and by occupational group alone. View larger version: In this window In a new window Incidence according to deprivation category in Scotland, 1998 (1=least deprived, 7=most deprived) No single, generally agreed definition of deprivation exists. Deprivation is a concept that overlaps but is not synonymous with poverty. Absolute poverty can be defined as the absence of the minimum resources for physical survival, whereas relative poverty relates to the standards of living in a particular society. Deprivation includes material, social, and multiple deprivation. In Scotland the Carstairs and Morris index of deprivation was derived from 1981 census data with the postcode sector as the basic geographical unit (covering a population of about 5000). This index describes a deprivation category on a scale of 1 (least deprived) to 7 (most deprived) for each household address in Scotland. View larger version: In this window In a new window Survival according to deprivation category in Scotland, 1998 (1=least deprived, 5=most deprived) The incidence of colorectal cancer is higher in men than women among each of the seven deprivation categories in Scotland, although incidence varies little with deprivation category. Survival, however, clearly improves with decreasing deprivation. At each milestone, there is a notable gradient in survival, with the most affluent doing best and the least affluent doing worst. The reasons that such variations exist are unclear and highlight an important priority for research. Further reading Boyle P . Progress in preventing death from colorectal cancer [editorial]. Br J Cancer 1995;72:528–30. Berrino F, Capocaccia R, Estève J, Gatta G, Hakulinen T, Micheli A, et al. , eds. Survival of cancer patients in Europe: the EUROCARE-2 study. Lyons: International Agency for Research on Cancer, 1999. (Scientific publication No 151.) Coleman MP, Babb P, Damiecki P, Grosclaude P, Honjo S, Jones J, et al . Cancer survival trends in England and Wales, 1971-1995: deprivation and NHS region. London: Stationery Office, 1999. Giovannucci E, Colditz GA, Stampfer MJ, Willett WC . Physical activity, obesity and risk of colorectal cancer in women (United States). Cancer Causes Control 1996;7:253–63. McLaren G, Bain M . Deprivation and health in Scotland: insights from NHS data. Edinburgh: ISD Scotland, 1998. MacLennan SC, MacLennan AH, Ryan P . Colorectal cancer and oestrogen replacement therapy: a meta-analysis of epidemiological studies. Med J Aust 1991;162:491–3. Parkin DM, Pisani P, Ferlay J . Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 1999;80:827–41. Shephard RJ . Exercise in the prevention and treatment of cancer an update. Sports Med 1993;15:258–80. Willett WC . The search for the causes of breast and colon cancer. Nature 1989;338:389–94. Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Speizer FE . Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women. N Engl J Med 1990;323:1664–72.

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