Socioeconomic position and survival after cervical cancer: influence of cancer stage, comorbidity and smoking among Danish women diagnosed between 2005 and 2010.

BACKGROUND: In an attempt to decrease social disparities in cancer survival, it is important to consider the mechanisms by which socioeconomic position influences cancer prognosis. We aimed to investigate whether any associations between socioeconomic factors and survival after cervical cancer could be explained by socioeconomic differences in cancer stage, comorbidity, lifestyle factors or treatment. METHODS: We identified 1961 cases of cervical cancer diagnosed between 2005 and 2010 in the Danish Gynaecological Cancer database, with information on prognostic factors, treatment and lifestyle. Age, vital status, comorbidity and socioeconomic data were obtained from nationwide administrative registers. Associations between socioeconomic indicators (education, income and cohabitation status) and mortality by all causes were analysed in Cox regression models with inclusion of possible mediators. Median follow-up time was 3.0 years (0.01-7.0). RESULTS: All cause mortality was higher in women with shorter rather than longer education (hazard ratio (HR), 1.46; 1.20-1.77), among those with lower rather than higher income (HR, 1.32; 1.07-1.63) and among women aged<60 years without a partner rather than those who cohabited (HR, 1.60; 1.29-1.98). Socioeconomic differences in survival were partly explained by cancer stage and less by comorbidity or smoking (stage- and comorbidity-adjusted HRs being 1.07; 0.96-1.19 for education and 1.15; 0.86-1.52 for income). CONCLUSION: Socioeconomic disparities in survival after cervical cancer were partly explained by socioeconomic differences in cancer stage. The results point to the importance of further investigations into reducing diagnosis delay among disadvantaged groups.

Cancer incidence among male Danish nurses, 1980-2003.

BACKGROUND: The cancer risk of female nurses has been examined in several studies, but none has addressed the risk of male nurses, although they may be exposed to the same carcinogens as female nurses. In this register-based cohort study, we explored cancer incidence among male Danish nurses. METHODS: We identified 3369 male nurses from the files of the Danish Nurses Association and followed them up from 1980 to 2003 in the Danish Cancer Registry. Standardized incidence ratios (SIRs) and 95% confidence intervals were calculated on the basis of standardized national rates. We compared the nurses with 3369 other male employees matched to the nurses by year of birth on social variables (vital and marital status). FINDINGS: We observed 90 cancers in the cohort, with significantly increased SIRs for sarcomas and decreased SIRs for cancers of the respiratory system. When the cohort was stratified by educational generation and birth cohort, we observed significantly elevated relative risks for cancers of the brain and nervous system among the youngest nurses and for sarcomas among nurses in all educational generations and those born between 1945 and 1954. CONCLUSION: The overall risk for cancer among male Danish registered nurses is similar to that of the general male Danish population. The high SIRs observed for cancers of the brain and nervous system merit further attention. The high relative risks for sarcomas and connective tissue tumours reflect a large proportion of cases of Kaposi sarcoma, which is probably not occupationally related.