The burden of cancer due to inequalities and its likely causes

Programme stream(s): Early detection / diagnosis and prognosis , Treatment

Chair: Yoryos Lyratzopoulos, University College London, UK
Speaker: Bernard Rachet, London School of Hygiene and Tropical Medicine, UK
Speaker: Jo Waller, University College London, UK
Speaker: Nancy Keating, Harvard Medical School and Dana Farber. USA

2:00 pm-4:00 pm

Room: Hall 1

The session will provide an overview of the state-of-the-evidence on the presence, magnitude and likely cause of inequalities in cancer pathways (with particular emphasis on inequalities in screening, diagnosis and treatment) and survival, and their likely causes.

The burden of cancer due to inequalities and its likely causes – Introduction
Speaker: Yoryos Lyratzopoulos
Affiliation: University College London


This brief scene-setting talk will review cancer inequalities as a phenomenon that permeates the cancer continuum (prevention-screening-symptomatic diagnosis-treatment-survivorship-survival). Different aspects of inequalities, by socio-demographic group and cancer site, and between organisations / countries, will be described. The likely aetiological contribution of tumour, host, or healthcare system factors as sources of cancer inequalities will be illustrated through the example of emergency presentations of cancer in England. Inequalities in non-clinical outcomes (patient experience) will also be illustrated.

Learning from research on cancer disparities in the US
Speaker: Nancy Keating
Affiliation: Harvard Medical School


Professor Keating will summarise conceptual aspects of cancer disparities by race/ethnicity and socioeconomic status, including the contribution of non-tumour (patient / healthcare system) factors to disparities. She will highlight evidence examining:

  1. a) the role of patient, provider, and health system factors in disparities in receipt of guideline-recommended cancer treatment
  2. b) the contribution of patient preferences in understanding treatment disparities, including end of life management
  3. c) the role of organisational or provider-level variation in care quality and the importance of understanding within vs. between hospital/organization disparities
  4. d) current health policies in the US that have potential to improve cancer care and lessen disparities.

Social inequalities in cancer screening participation
Speaker: Jo Waller
Affiliation: University College London


Across many developed countries, including the UK, participation in cancer screening is known to vary substantially by socio-economic status (or area-level deprivation) and ethnicity, and such inequalities contribute to poorer cancer outcomes in these demographic groups. The presentation will review existing evidence about inequalities in screening uptake and explore the potential usefulness of the Precaution Adoption Process Model (Weinstein et al, 2008) for understanding non-participatory behaviour, drawing on recent/ongoing research. It will focus on how we can better understand and intervene on psychological processes and behavioural factors that underpin inequalities in screening participation to improve cancer outcomes. The potential role of emotional and psychosocial correlates such as cancer fear, and practical barriers in screening participation will be additionally discussed. Beyond relevant evidence from established or emerging screening programmes (breast, bowel, cervical, lung), the presentation will also discuss the possible contribution of behavioural science in optimising the design and delivery of future screening interventions based on genetic, risk-stratified and novel biomarker technologies.

The role of individual and system factors on inequalities in cancer care and outcomes
Speaker: Bernard Rachet
Affiliation: London School of Hygiene and Tropical Medicine


Professor Rachet will provide an overview of a body of empirical work describing persistent socio-economic inequalities in cancer care and cancer survival in England and other countries, including within- and between-country comparisons. He will discuss methodological approaches that may help to decompose complex mechanisms leading to these inequalities, and offer a synthesis pointing towards the contribution of system-wide factors above and beyond the influences of individual (patient, tumour) factors.