Social epidemiology and the fundamental cause concept: on the structuring of effective cancer screens by socioeconomic status

Milbank Q. 1998;76(3):375-402, 304-5. doi: 10.1111/1468-0009.00096.


Since the early 1800s, studies have consistently demonstrated that people higher in the socioeconomic hierarchy live longer than people of lower rank. One hypothesis for the persistence of this association is that people who are relatively better off are more able to avoid risks by adopting currently available protective strategies. In a partial test of this idea, the social distributions of two cancer screening tests--Pap smears and mammography--were examined. A review of the literature and an analysis of Behavioral Risk Factor Surveillance System (BRFSS) data showed a consistent association between indicators of socioeconomic status and recent screening. These findings support the theory that societies create and shape patterns of disease. Innovations beneficial to health are carried out within the context of inequalities that shape the distribution of the health benefit, thereby affecting patterns of morality.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / prevention & control*
  • Diagnostic Tests, Routine / economics
  • Diagnostic Tests, Routine / standards
  • Diagnostic Tests, Routine / statistics & numerical data*
  • Female
  • Humans
  • Income / statistics & numerical data
  • Mammography / economics
  • Mammography / statistics & numerical data*
  • Middle Aged
  • Papanicolaou Test*
  • Population Surveillance
  • Poverty / statistics & numerical data
  • Program Development
  • Risk-Taking
  • Social Class
  • Socioeconomic Factors
  • United States / epidemiology
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / prevention & control*
  • Vaginal Smears / economics
  • Vaginal Smears / statistics & numerical data*