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Relationship between ethnicity and stage at diagnosis in England: a national analysis of six cancer sites

Fry, Anna; White, Becky; Nagarwalla, Diana; Shelton, Jon; Jack, Ruth H

Relationship between ethnicity and stage at diagnosis in England: a national analysis of six cancer sites Thumbnail


Anna Fry

Becky White

Diana Nagarwalla

Jon Shelton

Senior Research Fellow


Objectives: Cancer stage at diagnosis is a determinant of treatment options and survival. Previous research has shown differences in barriers to presentation with cancer between ethnic groups. The completeness and quality of cancer stage and ethnicity data has improved markedly over recent years in England, allowing for comparison of stage distributions at diagnosis between ethnic groups. This study aimed to assess relationships between ethnic group and two outcomes: unknown stage cancer and late stage (stages 3 and 4) cancer, after adjustment for confounders.
Design and setting: A retrospective secondary data analysis using data from NHS Digital's National Cancer Registration and Analysis Service and Hospital Episode Statistics records from 2012 to 2016.
Participants: This study analysed newly diagnosed breast, colon, non-small cell lung cancer (NSCLC), ovary, prostate and uterine cancers in white British, Caribbean, African, Chinese and Asian patients aged 15-99 in England.
Results: Caribbean, African and Asian women with breast or ovarian cancer, Caribbean and African women with uterine or colon cancer, Caribbean women with NSCLC and Caribbean men with colon cancer had increased odds of late-stage disease at diagnosis compared with the white British cohort. In contrast, Caribbean and African men with prostate cancer had decreased odds of late-stage cancer. Where stage was known, there were variations in late-stage cancer by ethnic group.
Conclusions: Low symptom awareness and barriers to presentation can cause delays, resulting in later stage diagnosis. Targeted intervention campaigns to help raise awareness of cancer signs and symptoms and the benefits of early diagnosis, along with removing barriers to appropriate referrals, could help to improve these inequalities.

Journal Article Type Article
Acceptance Date Nov 25, 2022
Online Publication Date Jan 26, 2023
Publication Date 2023-01
Deposit Date Jan 31, 2023
Publicly Available Date Feb 2, 2023
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ
Peer Reviewed Peer Reviewed
Volume 13
Issue 1
Article Number e062079
Keywords General Medicine
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