Why study socioeconomic factors and cancer?

The occurrence of cancer within a population can be studied at many different levels, including forms of social organization, the individual, a particular organ system, or a particular molecule. The causes of cancer can also be studied at these different levels, including socioeconomic factors, lifestyle, the organ burden of a carcinogen, or DNA adducts. Clearly, there are advantages in understanding disease causation at all of the different levels at which it operates. Although cancer risk factors such as tobacco smoke may appear to operate at the individual level, exposure may occur due to a wide range of political, economic and social factors; conversely, tobacco smoke ultimately also has effects at the cellular and molecular levels, including the production of mutations in DNA. Of course, it is important to gain information, and take action, at all possible levels, but the history of public health shows that changes at the population level are usually more fundamental and effective than changes at the individual level, even when a single risk factor accounts for most cases of disease. In this sense, a risk factor such as smoking can be regarded as a secondary symptom of deeper underlying features of the social and economic structure of society. Thus, just as a variety of health effects in various organ systems (for example, various types of cancer) may have a common contributing cause (for example, tobacco smoking) at the level of the individual, a variety of individual exposures (for example, smoking and diet) may have common socioeconomic causes at the population level. In many instances there is clear evidence that cancer is related to socioeconomic factors, but this does not appear to be fully explained by known risk factors. More importantly, there is little evidence as to which socioeconomic factors are of most importance, or whether it is the overall 'package' of social inequality that is responsible for the differences in cancer risk. The aim of this book is therefore to summarize what is already known, and to identify gaps in our knowledge.