Poor city dwellers die sooner from cancer, report finds
Canadians with lower income are often less likely to receive potentially life-saving cancer tests and treatments, according to a new report.
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Poor urban residents die sooner from cancer than their wealthy neighbours, a major report on Canada’s cancer system reveals.
The report by the Canadian Partnership Against Cancer, released Thursday, is the first national analysis to show that people living in lower-income areas — as well as in rural and remote communities — may not be accessing the best cancer care.
It found that the wealthiest urban residents have a 73-per-cent chance of surviving their cancers five years after diagnosis compared with 61 per cent for people living in the poorest urban areas.
The findings suggest the disparities are due to inequities in accessing diagnostic and treatment services.
“We need to do more work to understand how much of that is due to delayed diagnosis and how much is due to different access to cancer treatment,” said Dr. Heather Bryant, vice-president of cancer control at the Canadian Partnership Against Cancer.
The partnership is a non-profit, federally funded organization that works on implementing the country’s cancer control strategy. It drew on information from a number of sources, including hospital databases, national household surveys and provincial cancer registries.
The report builds on previous research that shows lower-income and rural Canadians have a greater risk of getting some cancers and dying from them because of higher rates of smoking and obesity.
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But it goes further by looking at gaps in survival, which tend to reflect differences in diagnosis and treatment as opposed to differences in the risk of getting the disease.
For example, it found significant disparities in screening, which is key to early diagnosis and can boost survival chances.
Screening rates for lowest- versus highest-income Canadians are: 61 per cent versus 77 per cent for breast cancer, 25 per cent versus 38 per cent for colorectal cancer, and 72 per cent versus 88 per cent for cervical cancer.
Offering possible explanations for the differences, Bryant said: “There may be less awareness. They may not be exposed to the same kinds and degrees of information as people with more education would be exposed to.”
It may also be more difficult for people with lower incomes to take time off work for screening, she said.
Recent immigrants are also less apt to be screened, something Bryant said may be due to language barriers or unease related to cultural differences.
People in lower-income neighbourhoods and those in remote communities are the least likely to participate in clinical trials of the latest cancer therapies.
Patients in remote communities are more likely to receive colostomies, rates of which are higher in smaller hospitals that handle fewer rectal cancers. A permanent colostomy involves removing the anal sphincter and redirecting fecal flow to an external bag on the abdomen and is generally associated with a poorer quality of life.
Meantime, higher-income and urban-dwelling women undergo fewer mastectomies than lower-income women and those residing in rural and remote communities. They opt instead for breast-conserving therapy.
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