Ethnic differences in the incidence Ethnic differences in the incidence of prostate cancer patients in UKof prostate cancer patients in UK

A reviewA review Presented ByPresented By

Steven L. YoungSteven L. YoungMasters CandidateMasters Candidate

Florida A&M University COPPSFlorida A&M University COPPS

Presented on behalf ofPresented on behalf of Francis Chinegwundoh Francis Chinegwundoh MBBS MS FRCS (Eng & Ed) FRCS(Urol) FEBUMBBS MS FRCS (Eng & Ed) FRCS(Urol) FEBU

Consultant UrologistConsultant UrologistBarts and The London NHS Trust, Barts and The London NHS Trust,

AcknowledgementAcknowledgement

Travel fund Travel fund • U.S U.S Department of Defense Prostate Department of Defense Prostate

Cancer Research Program W81XWH-Cancer Research Program W81XWH-04-1-032604-1-0326..

Dr. Folakemi Odedina Dr. Folakemi Odedina

Presentation OverviewPresentation Overview

IntroductionIntroduction StudiesStudies

• Chinegwundoh et al., 2006Chinegwundoh et al., 2006• The Prostate Cancer in Ethnic Subgroups The Prostate Cancer in Ethnic Subgroups

(PROCESS) study.(PROCESS) study. Conclusion?Conclusion?

I. IntroductionI. Introduction Data from the US, Africa, and the Data from the US, Africa, and the

Caribbean demonstrate that Caribbean demonstrate that significant ethnic variations for significant ethnic variations for prostate cancer risk exist.prostate cancer risk exist.• USAUSA

Disproportionate morbidity and mortality burden Disproportionate morbidity and mortality burden experienced by African American men. experienced by African American men.

• Caribbean countriesCaribbean countries African-Caribbean men, particularly Jamaican African-Caribbean men, particularly Jamaican

men, have the highest rate of prostate cancer in men, have the highest rate of prostate cancer in the world! the world!

• Africa – Limited dataAfrica – Limited data

United KingdomUnited Kingdom Is there a disproportionate burden for Is there a disproportionate burden for

prostate cancer among African-Caribbean prostate cancer among African-Caribbean men in the UK?men in the UK?

Prostate cancer is the most common Prostate cancer is the most common cancer among men.cancer among men.

Prostate cancer is of major public Prostate cancer is of major public health importance in the UK. health importance in the UK.

II. Studies ReviewedII. Studies Reviewed

Study 1Study 1

I. Risk and presenting features of prostate cancer amongst African-Caribbean, South Asian and European men in North-east London

Frank Chinegwundoh, Mohamed Enver, Angela Lee, Vinod Nargund, Tim Oliver and Yoav Ben-ShlomoBJU International 2006;98:1216-1220

BackgroundBackground Majority of the Black population in the UK are first Majority of the Black population in the UK are first

generation migrantsgeneration migrants• Could the risk of Prostate Cancer be as great as those of Could the risk of Prostate Cancer be as great as those of

African- American men in the US.African- American men in the US.

Minimal data on prostate cancer in ethnic groups Minimal data on prostate cancer in ethnic groups within the UK.within the UK.

It seems reasonable to assume that the greater It seems reasonable to assume that the greater relative risk for prostate cancer among African-relative risk for prostate cancer among African-American and Caribbean men will also be present American and Caribbean men will also be present for these populations in the UK.for these populations in the UK.

• Empirical data are required to confirm this assumptionEmpirical data are required to confirm this assumption

Sampling & MethodsSampling & Methods Study siteStudy site

• East London and City Health AuthorityEast London and City Health Authority Ethnically DiverseEthnically Diverse

Study designStudy design• Population-based, audit of all men Population-based, audit of all men

diagnosed with prostate cancer between diagnosed with prostate cancer between Jan 1, 1999 and Dec 31, 2000.Jan 1, 1999 and Dec 31, 2000.

• Cases identified through:Cases identified through: Centralized histology databaseCentralized histology database Urology & oncology department clinical Urology & oncology department clinical

databasesdatabases The Thames Cancer RegistryThe Thames Cancer Registry

Ethnic groupsEthnic groups• White White

British, Irish, “other” WhiteBritish, Irish, “other” White

• Asian Asian Indian, Pakistani, Bangladeshi, other Asian, Indian, Pakistani, Bangladeshi, other Asian,

White & Asian mixedWhite & Asian mixed

• Black Black Black Caribbean, black African, Other Black, Black Caribbean, black African, Other Black,

White and Black African mixed, White and White and Black African mixed, White and Black Caribbean mixedBlack Caribbean mixed

FindingsFindings

Age-adjusted incidence rates per 100 000

213

647

199

0

100

200

300

400

500

600

700

European African Caribbean South Asian

Ethnicity

Inc

ide

nc

e r

ate

Age-adjusted risk ratios by ethnicity

1

3.07

0.16

0

0.5

1

1.5

2

2.5

3

3.5

European African Caribbean South Asian

Age-adjusted risk ratios by ethnicity for men < 70years

1

3.34

0.56

0

0.5

1

1.5

2

2.5

3

3.5

European African Caribbean South Asian

““For every age group, the age-For every age group, the age-specific incidence rates were higher specific incidence rates were higher amongst African-Caribbean than amongst African-Caribbean than among European men.” (page 1217)among European men.” (page 1217)

““The threefold relative risk identified The threefold relative risk identified in the … study is much higher than in the … study is much higher than that found in the USA.” (page 1218)that found in the USA.” (page 1218)

Study 2Study 2

II. The Risk of Prostate Cancer II. The Risk of Prostate Cancer amongst Black Men in the United amongst Black Men in the United Kingdom: The Process Cohort Kingdom: The Process Cohort StudyStudy

Yoav Ben-Shlomo, Simon Evans, Fowzia Yoav Ben-Shlomo, Simon Evans, Fowzia Ibrahim, Biral Patel, Ken Anson, Frank Ibrahim, Biral Patel, Ken Anson, Frank Chinegwundoh et al. Chinegwundoh et al.

Eur Urol 2007 (in press)Eur Urol 2007 (in press)

Specific Aim: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 & MethodsSampling & Methods Study designStudy design

• Population- based retrospective Population- based retrospective cohort study recruiting all cases of cohort study recruiting all cases of prostate cancer diagnosed over a prostate cancer diagnosed over a 5-year period .5-year period .

Case definitionCase 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 Study sites had high proportion of Black residents:Black residents:• North Bristol• South West London• South East London• North East London

FindingsFindings

Total of 2140 incident cases.Total of 2140 incident cases.

Ethnic distributionsEthnic distributions• White – 1315 (61.4%)White – 1315 (61.4%)• Black Caribbean – 435 (20%)Black Caribbean – 435 (20%)• Black African – 102 (4.8%)Black African – 102 (4.8%)• Black unclassified – 10 (0.5%)Black unclassified – 10 (0.5%)• Other ethnic groups – 129 (6%)Other ethnic groups – 129 (6%)• Uncoded ethnicity - 149 (7%)Uncoded ethnicity - 149 (7%)

Age-adjusted prostate cancer rates per 100 000

56.4

165.5

0

20

40

60

80

100

120

140

160

180

European Black

Ethnicity

Ra

te

Age-adjusted prostate cancer rates per 100 000

56.4

173.1

139.3

0

20

40

60

80

100

120140

160

180

Rates

European Black Caribbean Black African

Ethnicity

Age-adjusted risk ratios by ethnicity

Black men vs White men

3.09

1

0

0.5

1

1.5

2

2.5

3

3.5

Black Men White men

Black Caribbean vs White men

3.19

1

0

0.5

1

1.5

2

2.5

3

3.5

Black CaribbeanMen White men

Black African vs White men

2.87

1

0

0.5

1

1.5

2

2.5

3

3.5

Black African Men White men

Black African vs Black Caribbean men

0.9

1

0.84

0.86

0.88

0.9

0.92

0.94

0.96

0.98

1

1.02

Black African Men Black Caribbean Men

“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?Conclusion?

It is still unclear why the risk of It is still unclear why the risk of Prostate Cancer is high among the Prostate Cancer is high among the Blacks.Blacks.

Genetic factorsGenetic factors Environmental factorsEnvironmental factors Access to healthcareAccess 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 More studies needed to understand the disproportionate burden of the disproportionate burden of prostate cancer experienced by prostate cancer experienced by Black men. Black men.