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Income, Education, and Breast Cancer Risk: How Are They Related?

Posted on December 29, 2021
Medically reviewed by
Todd Gersten, M.D.
Article written by
Elizabeth Wartella, M.P.H.

Factors including age, family history of breast or ovarian cancer, and ethnicity all contribute to the risk of breast cancer, but other environmental, lifestyle, and hormonal influences play a role in determining who develops breast cancer. Recently, public health research has focused on socioeconomic factors, like income and education, and their impact on chronic diseases like breast cancer. Scientists have found associations between the risk of breast cancer and socioeconomic status.

Specifically, higher incomes and higher levels of education have been found to correlate with an increased risk of breast cancer. While income and education themselves do not cause breast cancer, they may be associated with other factors that increase risk. Some of these factors include drinking alcohol, having fewer children, having children at a later age, and using hormone therapy after menopause.

Studies have also found that income and education levels may be associated with an earlier stage of cancer at diagnosis and better chances of survival.

It’s important to note that associations between income, education, and breast cancer risk do not prove causation. Environmental and socioeconomic factors only contribute to the possibility of getting breast cancer. Someone’s actual risk of getting breast cancer is determined by a complex combination of variables.

How Do Income and Education Impact Health?

Income and education are considered social determinants of health, or social conditions in a person’s life and environment that might play a role in their health and risk of disease. Medical professionals and organizations such as the Institute of Medicine acknowledge the role of social determinants of health in the development of chronic diseases and in creating or perpetuating health disparities among different groups of people.

Besides income and education, social determinants of health include things like exposure to air and water pollution, access to healthy food, and access to safe housing. Social determinants can join other factors such as a person’s genetics, biology, and lifestyle choices to play a role in the development of health conditions such as breast cancer.

Income, Education, and Breast Cancer Risk

Epidemiology studies in breast cancer examine different factors — like health, demographic, environmental, and lifestyle factors — among populations of people with breast cancer to help improve cancer prevention and treatment. Some of these studies highlight associations between high income and education and a higher risk of breast cancer.

According to a meta-analysis of 19 studies published from 1971 to 2019, income and education were positively associated with the risk of breast cancer. In other words, the study found that as income and education increased, the risk of breast cancer also increased. In this study, women in low-income groups showed a lower risk of breast cancer as well.

A meta-analysis and systematic review of 25 studies in Europe also found a significant relationship between higher socioeconomic status (some combination of education, income, and occupation) and increased risk of breast cancer.

Another study reviewed 18 studies totalling over 10 million women from the United States, Europe, and Japan. The review found that women with higher education levels had significantly higher incidence rates of breast cancer (number of new breast cancer cases) compared to women with lower education levels. The highest education was defined as some college-level education or higher, while the lowest education level was defined as less than a high school education.

Income, Education, and Breast Cancer Stage and Survival

Researchers have also found relationships between income and education with the stage of cancer (which describes the extent of cancer, whether the cancer is likely to spread, and how to best treat the cancer) and the chances of survival.

Early detection and diagnosis are important because tumors can grow larger and spread to other parts of the body over time. This can result in invasive breast cancer that is more difficult to treat. Education and income levels may influence early detection and contribute to different chances of survival.

Studies have found that higher income and education were associated with an earlier stage of cancer at diagnosis and better chances of survival. A Swedish study found that women who graduated from university had higher survival rates after a breast cancer diagnosis compared to women who completed less than nine years of education.

Other studies have found associations with lower levels of income and education and poorer chances of survival, plus an increased risk of being diagnosed at a later stage. Low socioeconomic status has been associated with an increased risk of aggressive, premenopausal breast cancers as well.

What all of this research means is that while people who have higher income and education levels may be more likely to develop breast cancer, they’re also more likely to have more favorable outcomes. On the other hand, people with lower income and education levels may be less likely to develop breast cancer. If they do develop breast cancer, however, it is more likely to be diagnosed at a later stage with poorer outcomes.

How Are Income and Education Linked to the Risk of Breast Cancer?

Researchers have developed some theories about why people who have higher education or higher incomes may have higher chances of developing breast cancer and lower chances of dying from breast cancer.

Other Risk Factors

Income and education may be associated with other risk factors that more directly influence the chance of developing breast cancer.

For example, alcohol consumption is considered a risk factor for breast cancer. People with high incomes may be more likely to drink alcohol, making alcohol consumption a possible link to income and the risk of breast cancer.

Other breast cancer risk factors that might serve as a link between income, education, and breast cancer include:

  • Having a first child at a later age
  • Having fewer children
  • Using birth control pills
  • Using hormone replacement therapy after menopause

According to the National Cancer Institute, other socioeconomic risk factors can play a role in cancer survival. Food insecurity, smoking, and obesity also may underlie disparities in cancer deaths between high- and low-income neighborhoods.

Breast Cancer Screening and Survival

Factors related to health care — like having health insurance, access to care, and access to breast cancer screenings — might play a role in the relationship between income, education, and breast cancer risk and outcomes. Income and education may make someone more likely to get regular breast cancer screenings. Regular mammograms can lead to earlier detection — and higher survival rates if cancer is found.

Breast cancer tumors found during regular screenings tend to be smaller, less advanced, and more treatable. If someone is more likely to get mammograms, then they may be more likely to have their cancer diagnosed at an earlier stage and have a lower chance of cancer mortality.

Having health insurance may also play a role in someone’s cancer treatment options and chances of survival. Breast cancer statistics from the American Cancer Society show that people with health insurance are more likely to get mammograms. If higher income and education may predict having health insurance, these factors would indirectly impact the likelihood of getting mammograms.

Health insurance status, access to health care, and mammography only play a role in the diagnosis of breast cancer; they do not definitively predict someone’s risk of breast cancer and chances of survival. However, it’s important to understand these aspects — and how they are influenced by education and income — to better understand and lower breast cancer incidence.

Talk to Others Who Understand

If you have breast cancer, talking to people who understand what you’re going through can be a great source of emotional support. MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 54,300 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Are you curious about the factors that influence breast cancer? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.

References
  1. Breast Cancer: Symptoms and Causes — Mayo Clinic
  2. Social Determinants of Health — U.S. Department of Health and Human Services
  3. Socioeconomic Status — Susan G. Komen Foundation
  4. The Future of the Public’s Health in the 21st Century — Institute of Medicine
  5. Explaining the Socioeconomic Variation in Cancer Risk in the Norwegian Women and Cancer Study — Cancer Epidemiology, Biomarkers, and Prevention
  6. Breast Cancer Incidence Patterns Among California Hispanic Women: Differences by Nativity and Residence in an Enclave — Cancer Epidemiology, Biomarkers, and Prevention
  7. Social Determinants of Breast Cancer Risk, Stage, and Survival — Breast Cancer Research and Treatment
  8. Socioeconomic Inequalities in Breast Cancer Incidence and Mortality in Europe — A Systematic Review and Meta-Analysis — European Journal of Public Health
  9. Education Level and Breast Cancer Incidence: A Meta-Analysis of Cohort Studies — Menopause
  10. Influence of Education Level on Breast Cancer Risk and Survival in Sweden Between 1990 and 2004 — International Journal of Cancer
  11. Influence of Occupation and Education Level on Breast Cancer Stage at Diagnosis, and Treatment Options in China — Medicine
  12. Alcohol — Susan G. Komen Foundation
  13. Relationship of Socio-Economic Status, Income, and Education With the Survival Rate of Breast Cancer: A Meta-Analysis — Iranian Journal of Public Health
  14. Breast Cancer Risk Factors — Cancer Treatment Centers of America
  15. Breast Cancer Facts and Figures 2019–2020 — American Cancer Society
  16. Early Detection Is Key — Carol Milgard Breast Center
Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Elizabeth Wartella, M.P.H. holds a masters in public health from Columbia University and is passionate about spreading accurate, evidence-based health information. Learn more about her here.

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