Richer men enjoy better prostate cancer care

There is a postcode lottery in prostate cancer treatment according to new research from Cambridge University published on bmj.com today. A study of over 35,000 men concludes that those living in economically deprived areas are far less likely to be offered the full range of possible treatments than those living in more affluent areas.

Researchers, led by Georgios Lyratzopoulos at the University of Cambridge, studied data on 35,171 men (aged 51 and over) between 1995 and 2006. Patients from the most deprived areas were:

• 26% less likely to have radiotherapy and
• 52% less likely to have radical surgery

than men who live in richer areas.

Prostate cancer is the most common cancer in men and its incidence has been increasing, particularly since the late 1980s and early 1990s. There appears to be a socioeconomic aspect to this too. In the introduction to their paper the researchers note that the disease is 20-40% more likely to  be noted in the most affluent areas but ‘like incidence, survival from prostate cancer is also socioeconomically patterned, with an absolute gap as high as 7% in five year relative survival between the least and most deprived individuals.’

One of the reasons suggested for the difference in diagnosis is that richer men are less reluctant to have a prostate specific antigen (PSA) screening test.

During the period of the study, the proportion of patients offered surgery increased significantly. From 2.9% during 1995-7 to 8.4% during 2004-6. Use of radiotherapy for patients remained stable at around 25% throughout the study period.

The researchers found that either radiotherapy or surgery was used more often in the most affluent people

Radiotherapy was used for the most affluent people in 28.5% of cases, compared with 21% of people from the most deprived areas – a 26% difference. Similarly, surgery was used for 8.4% of the better off people, compared with just 4% of the worse off patients – a 52% difference.

This pattern persisted even when factors such as age, hospital of diagnosis and disease stage were taken into consideration.

The researchers say the causes and impact on survival of such differences between socioeconomic groups remain uncertain, and call for further research to help explain the socioeconomic differences in treatment.

In an accompanying editorial in the BMJ, researchers in Finland suggest that, when discussing treatment decisions, ‘better educated patients may process information more easily and doctor-patient communication may be more effective or fluent when doctor and patient have similar social backgrounds.’

Does cold weather cause cancer?

Of course, it may just been down to the weather. Research from Idaho State University published in International Journal of Health Geographics suggests a link between prostate cancer and the effect of cold dry weather on pollutants.

The team led by research associate professor Sophie St-Hilaire studied the correlation between weather conditions and the county level incidence of prostate cancer across the United States, controlling for variables

‘We found that colder weather and low rainfall were strongly correlated with prostate cancer,’ St-Hilaire said. ‘Although we can’t say exactly why this correlation exists, the trends are consistent with what we would expect given the effects of climate on the deposition, absorption, and degradation of persistent organic pollutants, including some pesticides.’

Cold weather appears to slows the degradation of pollutants such as PCBs (Polychlorinated biphenyls) and DDT (dichlorodiphenyltrichloroethane) – both now supposedly banned - while also causing them to head towards the ground. Rain and humidity also play important roles in their absorption and degradation, say the researchers.