Ethnic differences in the incidence of prostate cancer patients in UK A review
Presented By
Steven L. Young
Masters Candidate
Florida A&M University COPPS
Presented on behalf of Francis Chinegwundoh Consultant Urologist Barts and The London NHS Trust,
MBBS MS FRCS (Eng & Ed) FRCS(Urol) FEBU
Acknowledgement
Travel fund
• U.S Department of Defense Prostate
Cancer Research Program W81XWH04-1-0326.
Dr. Folakemi Odedina
Presentation Overview
Introduction Studies
• Chinegwundoh et al., 2006 • The Prostate Cancer in Ethnic Subgroups (PROCESS) study.
Conclusion?
I. Introduction
Data from the US, Africa, and the Caribbean demonstrate that significant ethnic variations for prostate cancer risk exist.
• USA
Disproportionate morbidity and mortality burden experienced by African American men. African-Caribbean men, particularly Jamaican men, have the highest rate of prostate cancer in the world!
• Caribbean countries
• Africa – Limited data
United Kingdom
Is there a disproportionate burden for prostate cancer among African-Caribbean men in the UK?
Prostate cancer is the most common cancer among men.
Prostate cancer is of major public health importance in the UK.
II. Studies Reviewed
Study 1
I. Risk and presenting features of prostate cancer amongst AfricanCaribbean, South Asian and European men in North-east London
Frank Chinegwundoh, Mohamed Enver, Angela Lee, Vinod Nargund, Tim Oliver and Yoav Ben-Shlomo BJU International 2006;98:1216-1220
Background
Majority of the Black population in the UK are first generation migrants
• Could the risk of Prostate Cancer be as great as those of AfricanAmerican men in the US.
Minimal data on prostate cancer in ethnic groups within the UK.
It seems reasonable to assume that the greater relative risk for prostate cancer among African-American and Caribbean men will also be present for these populations in the UK.
• Empirical data are required to confirm this assumption
Sampling & Methods
Study site
• East London and City Health Authority
Ethnically Diverse
Study design
• Population-based, audit of all men diagnosed with prostate cancer between Jan 1, 1999 and Dec 31, 2000. • Cases identified through:
Centralized histology database Urology & oncology department clinical databases The Thames Cancer Registry
Ethnic groups
• White
British, Irish, “other” White
• Asian
Indian, Pakistani, Bangladeshi, other Asian, White & Asian mixed Black Caribbean, black African, Other Black, White and Black African mixed, White and Black Caribbean mixed
• Black
Findings
Age-adjusted incidence rates per 100 000
700 600 647
Incidence rate
500 400 300 200 100 0 European African Caribbean Ethnicity South Asian 213 199
Age-adjusted risk ratios by ethnicity
3.5 3 2.5 2 1.5 1 0.5 0 European African Caribbean South Asian 0.16 1
3.07
Age-adjusted risk ratios by ethnicity for men < 70years
3.5 3 2.5 2 1.5 1 0.5 0 European African Caribbean South Asian 1 0.56 3.34
“For every age group, the agespecific incidence rates were higher amongst African-Caribbean than among European men.” (page 1217) “The threefold relative risk identified in the … study is much higher than that found in the USA.” (page 1218)
Study 2
II. The Risk of Prostate Cancer amongst Black Men in the United Kingdom: The Process Cohort Study
Yoav Ben-Shlomo, Simon Evans, Fowzia Ibrahim, Biral Patel, Ken Anson, Frank Chinegwundoh et al. Eur Urol 2007 (in press)
Specific Aim:
• establish a UK population-based clinical cohort of white men and black men of African and Caribbean ancestry, to derive, for the first time:
robust estimates of incidence rates compare the relative risks of developing prostate cancer
Sampling & Methods
Study design
•Population- based retrospective cohort study recruiting all cases of prostate cancer diagnosed over a 5-year period .
Case definition
• Histologically proven or a clinical diagnosis of prostate cancer • 5-yr period
Pilot study1995–1999 Main data collection 1997–2001
Study sites had high proportion of Black residents:
• North Bristol • South West London • South East London • North East London
Findings
Total of 2140 incident cases.
Ethnic distributions
• White – 1315 (61.4%) • Black Caribbean – 435 (20%) • Black African – 102 (4.8%) • Black unclassified – 10 (0.5%) • Other ethnic groups – 129 (6%) • Uncoded ethnicity - 149 (7%)
Age-adjusted prostate cancer rates per 100 000
180 160 140 120 165.5
Rate
100 80 60 40 20 0
56.4
European Ethnicity
Black
Age-adjusted prostate cancer rates per 100 000
180 160 140 120 100 Rates 80 60 40 20 0 173.1 139.3
56.4
European
Black Caribbean Ethnicity
Black African
Age-adjusted risk ratios by ethnicity
Black men vs White men
3.5 3 2.5 2 1.5 1 1 0.5 0 Black Men White men 3.09
Black Caribbean vs White men
3.5 3 2.5 2 1.5 1 1 0.5 0 Black CaribbeanMen White men 3.19
Black African vs White men
3.5 3 2.5 2 1.5 1 1 0.5 0 Black African Men White men 2.87
Black African vs Black Caribbean men
1.02 1 0.98 0.96 0.94 0.92 0.9 0.88 0.86 0.84 Black African Men Black Caribbean Men 0.9 1
“Black men have a 3-fold greater risk of developing prostate cancer …”
“… there is little difference between men of Caribbean or African origin.”
No evidence of worse prognosis for Black men.
Conclusion?
It is still unclear why the risk of Prostate Cancer is high among the Blacks.
Genetic factors Environmental factors Access to healthcare
There is genetic similarity among Black African men from West Africa, Black Caribbean men & African American men.
• Are Black men of West African ancestry at risk for prostate cancer?
More studies needed to understand the disproportionate burden of prostate cancer experienced by Black men.