Better prostate cancer care for highly educated

Men with advanced degrees and higher income are more likely to receive certain care and treatment for prostate cancer. Their risk of dying from the disease is also lower than for men with low income and education level. These are the findings of a study conducted at the University of Gothenburg.

Behind the study, published in International Journal of Cancer, is a group of researchers from Sahlgrenska Academy at the University of Gothenburg, Karolinska Institutet, Uppsala University and Umeå University.

The foundation for the study was drawn from the research database PCBaSe, which contains data from several national registries, including the National Prostate Cancer Registry. The study included data on more than 32,000 men in total. What was analyzed was the relationship between income and education, and several important measures of prostate cancer care.

Clear links to education and income

The results clearly show that education and income affect the evaluation and treatment of men with suspected or newly diagnosed prostate cancer.

Advanced degrees and higher income were associated with an increased likelihood of having an MRI scan for evaluation of suspected prostate cancer, during the 2018 to 2020 implementation phase. The proportion completing this examination was 47%, compared to 35% in the groups with shorter education and lower income.

Those with more advanced degrees or higher income were also more likely to receive curative treatment for severe prostate cancer that had not spread. The percentages ranged from 89% to 75% in the different groups.

Similar differences were found for repeat prescription of erection-boosting tablets after prostate cancer surgery. The proportion of men receiving this rehabilitation varied between 44 and 52%, depending on education and income.

The proportion of men with a fatal outcome of a serious prostate cancer that had not spread was clearly higher for men with lower education or income than for men with advanced degrees or higher income. For low income versus high, the proportions that died were 12.5% and 8.5%, respectively. The differences were mainly due to that men with a short education and lower income had a more severe disease at diagnosis, not to that they received poorer care after diagnosis.

Possible ways to reduce inequality

“Although Sweden is relatively socioeconomically equal, the results show differences in cancer care according to income and education. In an international comparison, the differences are quite small,” says Ola Bratt, Professor of Clinical Cancer Epidemiology at the University of Gothenburg, Consultant Urologist at Sahlgrenska University Hospital, and the principal investigator of the study.

The researchers see organized prostate cancer testing as a possible way to improve equality in diagnosis. Ulf Strömberg is Adjunct Professor of Epidemiological Methodology at the University of Gothenburg, an epidemiologist at Region Kronoberg, and one of the researchers conducting the study:

“There are many indications that efforts to increase equality are mainly needed in diagnostics so that prostate cancer can be detected at an earlier stage in men from socioeconomically vulnerable groups,” he says.