Differences in Colorectal Cancer Incidence between the Education Groups have Narrowed. That’s a Good Thing, Right?

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“..the ideal goal would be a more active, healthy eating population” (photo: pexels.com)

By: Sanna Heikkinen

Colorectal cancer incidence keeps increasing in Finland, in all age groups. According to the recent study by the Finnish Cancer Registry, this upwards trend also applies to all education groups. Differences between the groups have, however, narrowed over the past decades and this could be considered as a fine achievement in our pursuit of equality in health. However, a more careful look at the achieved “equality” sadly reveals something we wouldn’t have hoped for – colorectal cancer has increased the most in the low education group, where the incidence used to be the lowest. In the higher education groups, the increase has been more moderate. All of this results in smaller differences between the groups.

Considering that colorectal cancer is mainly influenced by factors related to lifestyle, this is no surprise. Finnish society has become more homogenous in terms of lifestyle habits. According to the National Institute for Health and Welfare, alcohol consumption has increased more in the lower education groups, bringing them closer to the group with higher education, who used to consume alcohol the most in the 1980s. The consumption is now equally high in all education groups. The consumer prices for red meat have come down and is thus nowadays more easily available for everyone. Overall, the annual consumption of red meat in Finland has increased from 60,5 kg per person in 1976 to 80 kg per person in 2014, according to the Luke Natural Resources Institute Finland. Smoking has decreased in all education groups but remains highest among persons with low education. To put it simply, certain harmful lifestyle habits are now more evenly distributed across the education groups than before.

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“the [alcohol] consumption is now equally high in all education groups” (picture: pexels.com)
We would have hoped that the narrowing of incidence differences would be a result of lowered incidence in the higher education groups – because of their decreased use of meat and alcohol and so forth. Of course, in real life and beyond statistics, we must look at the bigger picture instead and aim at lowering the risk of colorectal cancer in its entirety. We still can’t fully eliminate colorectal cancer, as there are other causal environmental or genetic factors we are currently unaware of and which we can do nothing about, but the ideal goal would be a more active, healthy eating population that decreases its own cancer risk as much as possible.  Still, even if the epidemiologically interesting “equalization” between the education groups has happened at the expense of an increased number of new cancer cases among those with low education, there is a silver lining.

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Figure 1. Colorectal cancer incidence in Finland in 1976-2015 by education groups. Finnish Cancer Registry/Karri Seppä

We now know more clearly that in regards to colorectal cancer prevention, the focus should be on certain well-known lifestyle factors and therefore no need for tailored recommendations for different demographic groups. The same message can be applied to all of us; don’t smoke, reduce the consumption of alcohol and red and processed meat, be physically active and stay slim. The task is much trickier for example in breast cancer, where we would need to encourage highly educated women to have more children and at an earlier age – thus we would not only need to target our enlightenment efforts, but also ask for something that we can’t really ask. In this sense, campaigning for colorectal cancer prevention should be an easy task.

Of course, we all know that it’s just not that simple, modern life can be hectic and demanding, but it’s up to individuals to make better choices daily, such as standing at work instead of sitting or making a vegetarian dish instead of one made from processed red meat. Our task is to provide evidence-based information on factors possibly affecting your health in which we hope people will choose to base their lifestyle decisions on.

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Sanna Heikkinen PhD, scientist at the Finnish Cancer Registry

Click here to read the article on the “Trends of colorectal cancer incidence by education and socioeconomic status in Finland” by Savijärvi et al.

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