A consultation with 2 people and a doctor

The first analysis in over 10 years looking at which ethnic groups in England are more likely to get cancer has now been published by Cancer Research UK analysts.

The research shows rates of some cancers vary by ethnicity.

White people in England, are more than twice as likely to get some types of cancer, including melanoma skin cancer, oesophageal, bladder and lung cancers compared with people from Black, Asian or Mixed ethnic backgrounds. Likely in part due to preventable risk factors such as smoking and obesity.

However, prostate cancer, myeloma (a type of blood cancer) and womb cancer, are all more common in Black people. The study also found that Black people are more likely to get stomach and liver cancers, and Asian people are more likely to get liver cancers.

Any increase in cancer rates is concerning to the charity. With some evidence suggesting smoking and obesity rates in people from Black, Asian or Mixed ethnic backgrounds could become similar to those in White people in future, experts warn that cancer rates in minority ethnic groups could increase. Given existing inequalities in patient experience, which includes people from minority ethnic groups reporting worse experiences of cancer care and lower survival for some cancer types seen, this is worrying.

Knowing the differences, if any, in cancer rates in different ethnic groups is a key piece of the puzzle when it comes to reducing those differences and improving patient experience.

To date, this is the most reliable and highest quality study on cancer incidence by ethnicity in England, which shows us there are disparities in cancer rates across different ethnicities,” said Dr Katrina Brown, one of the study authors and a Cancer Research UK statistician.

Getting a better picture

Before today, the most recent analyses that looked at the relationship between ethnicity and cancer incidence in England used data up to 2006 and 2007.

“Ethnicity recording in cancer data at that time was quite incomplete,” said Dr Christine Delon, lead author of the paper. “Around a quarter of cancer cases didn’t even have an ethnic group recorded. Data quality has improved now, and the composition and risk factor prevalence of England’s minority ethnicity populations may have also changed over the past decade, so new information has been sorely needed.”

“It’s really important to understand what the evidence is, where there are inequalities in cancer incidence, to inform efforts in risk factor prevention and cancer service planning and delivery.”

This new analysis, published in the British Journal of Cancer, looked at the variations in cancer incidence rates (the average number of new cancer cases for every 100,000 people per year) between Asian, Black, Mixed ethnicity and White ethnic groups in England, as recorded by the National Cancer Registration and Analysis Service using data direct from hospitals. The team used data from between 2013 and 2017, taking into account differences in population size and age by using age-standardised rates rather than numbers of cases.

Key results:

  • In all broad ethnic groups, lung, bowel, breast and prostate cancers were the 4 most common cancer types.
  • Asian and Black people as well as people with Mixed ethnic backgrounds have lower rates of cancer for the majority of cancer types, compared with White people.
  • A small number of cancer types are more common in certain ethnic groups compared with White people, including myeloma and stomach cancer in Black people, gallbladder cancer in Black and Asian people, and prostate cancer in Black men.
  • Black and Asian people have far lower rates of melanoma skin cancer than White people.

Why do differences exist?

The differences seen in cancer incidence between people from different ethnic backgrounds are likely largely driven by non-genetic cancer risk factors.

In particular, smoking rates, and overweight and obesity rates – the two largest preventable causes of cancer in the UK – have historically been higher in White people than many other ethnic groups. This is likely to at least partially explain the differences seen in certain types of cancer, including bowel, breast and lung cancers.

“Smoking is the biggest cause of cancer in England and being overweight or obese is the second. Access to stop smoking and weight management services is vital to make sure everyone has the opportunity to reduce their risk of cancer,” said Delon.

Screening uptake is also probably a factor, as studies have shown that White people are generally more likely to attend.

But genetics are also likely to play at least a small role.

“An obvious genetic element associated with ethnicity is skin colour,” said Delon. “And we see that impact on skin cancer risk, where White people are more than ten times more likely to develop melanoma than Black people, and that’s a bigger difference than for any other cancer type.”

However, the genetics that vary between ethnicities is tiny compared to what is shared, which can make determining why some cancer types affect certain ethnic groups more than others very difficult when preventable risk factors aren’t thought to be playing the main role.

For example, this new paper shows Black people in England are almost 3 times more likely to get myeloma than White people, and Black men are also twice as likely to get prostate cancer compared with White men.

This is probably in part due to an increased genetic risk, but the picture is quite complex, and experts still don’t have all the answers.

What happens now?

“It’s really positive that more cancer records than ever before contain ethnicity information. There are still issues with the reliability of that information when we get to more specific ethnic groups. And a high level of detail is needed to really dig into why cancer rates vary, and how cancer services may need to adapt to the changing demographics of the cancer patient population,” said Delon.

This latest analysis, which is the first study of its kind for a decade, shows that cancer rates are currently not equal between different ethnic groups. And it’s likely that, at least in part, this could be down to risk factors that tend to be more common in White people, like smoking and obesity.

However, whilst White people are currently more likely to get most types of cancer, experts are worried cancer rates in people from Black, Asian or Mixed ethnic backgrounds could rise in the future, as evidence suggests the ethnicity gap in smoking and obesity rates is narrowing.

And the number of people getting cancer is just the start.

“Patient survey data has shown that when people from ethnic minority backgrounds do get cancer, they feel less satisfied with their care and have less confidence in health professionals, compared with people from the White ethnic group,” said Delon. “They are also more likely to be diagnosed at a later stage and have lower survival for some cancer types.”

Experts are keen to understand why these differences in patient experience exist and how to address them.

“We need to make sure that people of every ethnic group, and every background, get the diagnosis and treatment they need, so that everyone can have the best possible outcomes.”