Main description:

This contributed volume addresses the link between the social environment and cancer in Europe. The authors document the wide range and diverse trends in cancer incidence and patient survival in Europe, and they identify the main mechanisms and key influences that underlie these inequalities. They suggest a series of actions and programmes to tackle these inequalities in Europe, within the conceptual framework of intervention research.
The influence of the social environment on the risk of suffering and dying from cancer is obviously a global phenomenon, as evidenced by a growing number of studies and books. In part, the underlying mechanisms are universal. Given the availability of a new standardised measure for social deprivation in Europe (the European Deprivation Index), the networking of population-based cancer registries across Europe as efficient surveillance tools, the increasing comparability of the organisation of care in European countries, and the recent launch of Europe's Beating Cancer Plan, this extensive review of social inequalities in cancer on a European scale is both relevant and timely.
The book consists of 21 chapters organised in four sections:

Part I - General Considerations and Methodologic Aspects
Part II - Social Disparities in Cancer Incidence and Survival - Reports
Part III - Social Disparities in Cancer Incidence and Survival - Mechanisms
Part IV - Towards an Evidence-Based Policy for Tackling Social Inequalities in Cancer

Social Environment and Cancer in Europe: Towards an Evidence-Based Public Health Policy is a unique resource that presents up-to-date methods for analysing quantitative data. It focusses on inequalities in cancer incidence and survival within the wider framework of inequalities in health. This book will be an essential reference for policy-makers, researchers, public health professionals, social scientists and oncologists.

Contents:

The final book consists of 21 chapters organized in 4 parts (below has not been updated and reflects original proposal)

Part A - General Considerations

I Social inequalities in cancer. What are we talking about ? - Basic concepts

This chapter defines the objective of the research and proposes a definition for each word by being inspired, for example, by the writings of Louise Potvin, placing the reflection in its general philosophical, ethical, and social framework. The chapter defines in this context the scientific approach of epidemiological researchers and public health managers and shows its specific contribution in a multi-disciplinary framework. Finally, the chapter draws up a quick historical perspective in order to place this book in the history of research on the subject.

II Assessment of social environment - The European deprivation Index (EDI). A tool for an evidence-based policy at a European level

This chapter describes the objectives, the means and the limits of the individual and aggregated assessments of the social environment. The chapter defines the purpose and the principles of construction of the EDI, as well as its mode of use and its perspectives of development

III Cancer registration in Europe - A tool for an evidence-based policy at a national and European level

This chapter describes the current state of cancer registries in Europe and their coordination at the European level. It is also about promoting their activity and their sustainability by showing how it represents a unique database with considerable potential in the knowledge of cancers, their potential link with the social environment. The chapter also shows how they can constitute a unique tool for the evaluation of public health policies at the national or European level.

Part B - Reports on Incidence

IV Methodological considerations for studying social disparities in cancer incidence

The chapter presents the specificities of the geographical approaches in the study of the incidence, its statistical implications, the principal models of statistical analysis, their interest, their mode of use, and their limits.

V - Social disparities in Cancer Incidence for adults throughout Europe.

This chapter aims to take stock of national or international studies that have investigated the link between the social environment and the incidence of cancer by limiting themselves to Europe and studies based on cancer registry data. It may be necessary to consider two parts, one dealing with the social status (individual level) and the other with the social environment (neighbouring studies)

VI- Social disparities in Cancer Incidence for children throughout Europe

This chapter aims to take stock of national or international studies that have investigated the link between the social environment and the incidence of cancer by limiting themselves to Europe and studies based on cancer registry data

Part C - Reports on Survival

VII Methodological considerations for studying social determination of survival

This chapter presents the purpose, the interest and the principles of the development of the net survival as well as the statistical developments necessary to take into account the hierarchy of the data (multilevel analysis).

VIII Social disparities in cancer survival in adults in Europe. Data from CONCORD study

This chapter aims to extract from the Concord study all results from European registers and to show how the inter-country differences observed can be explained by social elements due to the level of socio-economic development of countries or their social organization and care

IX Social disparities in survival for breast cancer in Europe

This chapter aims to take stock of national or international studies that have investigated the link between the social environment and survival for breast cancer in European countries. Studies can consist of population-based studies, cohorts, or other prospective studies. It may be necessary to consider two parts, one dealing with the social status (individual level) and the other with the social environment (neighbouring studies) and to summarize the main hypothesis for underlying mechanisms.

X Social disparities in survival for colorectal cancer in Europe

This chapter aims to take stock of national or international studies that have investigated the link between the social environment and survival for colorectal cancer in European countries. Studies can consist of population-based studies, cohorts, or other prospective studies. It may be necessary to consider two parts, one dealing with the social status (individual level) and the other with the social environment (neighbouring studies) and to summarize the main hypothesis for underlying mechanisms.

XI Social disparities in survival for prostate cancer in Europe

This chapter aims to take stock of national or international studies that have investigated the link between the social environment and survival for prostate cancer in European countries. Studies can consist of population-based studies, cohorts, or other prospective studies. It may be necessary to consider two parts, one dealing with the social status (individual level) and the other with the social environment (neighbouring studies) and to summarize the main hypothesis for underlying mechanisms.

XII Social disparities in survival for lung cancer in Europe

This chapter aims to take stock of national or international studies that have investigated the link between the social environment and survival for lung cancer in European countries. Studies can consist of population-based studies, cohorts, or other prospective studies. It may be necessary to consider two parts, one dealing with the social status (individual level) and the other with the social environment (neighbouring studies) and to summarize the main hypothesis for underlying mechanisms.

XIII Social disparities in survival for head and neck cancer in Europe

This chapter aims to take stock of national or international studies that have investigated the link between the social environment and survival for head and neck cancer in European countries. Studies can consist of population-based studies, cohorts, or other prospective studies. It may be necessary to consider two parts, one dealing with the social status (individual level) and the other with the social environment (neighbouring studies) and to summarize the main hypothesis for underlying mechanisms.

XIV Social disparities in survival for cancer for children in Europe

This chapter aims to take stock of national or international studies that have investigated the link between the social environment and survival for children with cancer in European countries. Studies can consist of population-based studies, cohorts, or other prospective studies. It may be necessary to consider two parts, one dealing with the social status (individual level) and the other with the social environment (neighbouring studies) and to summarize the main hypothesis for underlying mechanisms.

Part D - Mechanisms

XV General considerations. General model (proximal and distal factors). Different models for incidence and survival. Methodological framework

This chapter presents Daghren-Whitehall's general model of social inequalities in health by applying it to oncology, to explain proximal and distal factor concepts, to emphasize macroeconomic factors and the role of policy choices regarding especially the organization of care and social protection and industry manufacturing control, to explain the concept of social gradient and its relevance in oncology. The chapter also elicits interest in developing statistical models that fit such a causal model with different pathways. Finally, it seems worthwhile to explain the importance of proposing two explanatory models, one for the social gradient of incidence, the other for the social gradient of survival, as well as the nature of the factors involved and above all the actions to be taken to counter them.Mechanism of the social gradient in cancer Incidence in Europe

XVI- Behavioural factors in social gradient for cancer incidence

The chapter lists the set of socially determined behaviors that constitute known risk factors for cancers: tobacco, alcohol, diet, sedentary lifestyle, sexual behavior, etc., supporting their association with the risk of cancer and their social determination via an adapted bibliography. It is an analysis for the most socially determined cancer sites. It is also necessary to take into account the frequency of these different cancer sites to develop an "attributable risk" approach

XVII - Occupational factors in social gradient for cancer incidence

The chapter lists the set of occupational exposures that can be involved in the social gradient in cancer incidence supporting their association with the risk of cancer and their social determination via an adapted bibliography. It is an analysis for the most socially determined cancer sites. It is also necessary to take into account the frequency of these different cancer sites to develop an "attributable risk" approach

XVIII Contextual factors in social gradient for cancer incidence

The chapter aims to explain the concept of contextual factors and present the methods that can highlight them and study their influence on the risk of cancer. It is a matter of citing the main contextual elements for which there is currently evidence for their impact on cancer incidence (green spaces, road traffic noise. etc.)

XIX- Allostatic load and life-course hypothesis

This chapter explains the hypotheses of the allostatic charge and more generally the hypothesis in accordance with the social environment. It is also necessary to support the hypotheses with the most recent results that come from a cohort study or a biological and epigenetic approach.

Social gradient in patient survival in Europe

XX- Role of Screening in social gradient in breast cancer survival in Europe

This chapter reviews main reports on social disparities in breast cancer screening programmes in European countries, to evoke the main social barriers to screening, and to summarize studies assessing the impact of lower participation in the screening of deprived people on the survival of people with cancer

XXI- Role of Screening in social gradient in colorectal cancer survival in Europe

This chapter reviews main reports on social disparities in colorectal cancer screening programmes in European countries, to evoke the main social barriers to screening and to summarize studies assessing the impact of lower participation in the screening of deprived people on the survival of people with cancer

XXII- Role of Geographical remoteness

This chapter reviews main reports on the influence of geographical remoteness, and distance to hospitals and other care suppliers on cancer patient survival in European countries

XXIII- Role of comorbidities in social gradient in cancer survival

This chapter reviews main reports on the potential role of comorbidity on social gradient in cancer patient survival in European countries. This chapter also argues the need of mortality tables by deprivation in European countries.

XXIV - Role of Diagnosis and Treatment in social gradient in cancer survival in Europe

This chapter reviews main reports on the potential role of comorbidity on social gradient in cancer patient survival in European countries

Part E - Actions and Policies

XXV - Organisation and funding of health system and social inequalities in cancer - Towards an evidence-based policy for tackling social inequalities

XXVI - Links between research in public health and public health policy. The conceptual framework of "interventionnal research" - the place of cluster randomized trials - conceptual and methodological framework

XXVII - Social inequalities in cancer - the policy of the European Commission