1. 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 MBBS MS FRCS (Eng & Ed) FRCS(Urol) FEBU Consultant Urologist Barts and The London NHS Trust,

2. Acknowledgement Travel fund Travel fund U.S Department of Defense Prostate Cancer Research Program W81XWH- 04-1-0326.U.S Department of Defense Prostate Cancer Research Program W81XWH- 04-1-0326. Dr. Folakemi Odedina Dr. Folakemi Odedina

3. Presentation Overview Introduction Introduction Studies Studies Chinegwundoh et al., 2006Chinegwundoh et al., 2006 The Prostate Cancer in Ethnic Subgroups (PROCESS) study.The Prostate Cancer in Ethnic Subgroups (PROCESS) study. Conclusion? Conclusion?

4. I. Introduction Data from the US, Africa, and the Caribbean demonstrate that significant ethnic variations for prostate cancer risk exist. Data from the US, Africa, and the Caribbean demonstrate that significant ethnic variations for prostate cancer risk exist. USAUSA Disproportionate morbidity and mortality burden experienced by African American men. Disproportionate morbidity and mortality burden experienced by African American men. Caribbean countriesCaribbean countries African-Caribbean men, particularly Jamaican men, have the highest rate of prostate cancer in the world! African-Caribbean men, particularly Jamaican men, have the highest rate of prostate cancer in the world! Africa – Limited dataAfrica – Limited data

5. United Kingdom United Kingdom Is there a disproportionate burden for prostate cancer among African-Caribbean men in the UK? 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 the most common cancer among men. Prostate cancer is of major public health importance in the UK. Prostate cancer is of major public health importance in the UK.

6. II. Studies Reviewed Study 1

7. 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-Shlomo BJU International 2006;98:1216-1220

8. Background Majority of the Black population in the UK are first generation migrants Majority of the Black population in the UK are first generation migrants Could the risk of Prostate Cancer be as great as those of African- American men in the US.Could the risk of Prostate Cancer be as great as those of African- American men in the US. Minimal data on prostate cancer in ethnic groups within the UK. 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. 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 assumptionEmpirical data are required to confirm this assumption

9. Sampling & Methods Study site Study site East London and City Health AuthorityEast London and City Health Authority Ethnically Diverse Ethnically Diverse Study design Study design Population-based, audit of all men diagnosed with prostate cancer between Jan 1, 1999 and Dec 31, 2000.Population-based, audit of all men diagnosed with prostate cancer between Jan 1, 1999 and Dec 31, 2000. Cases identified through:Cases identified through: Centralized histology database Centralized histology database Urology & oncology department clinical databases Urology & oncology department clinical databases The Thames Cancer Registry The Thames Cancer Registry

10. Ethnic groups Ethnic groups WhiteWhite British, Irish, “other” White British, Irish, “other” White AsianAsian Indian, Pakistani, Bangladeshi, other Asian, White & Asian mixed Indian, Pakistani, Bangladeshi, other Asian, White & Asian mixed BlackBlack Black Caribbean, black African, Other Black, White and Black African mixed, White and Black Caribbean mixed Black Caribbean, black African, Other Black, White and Black African mixed, White and Black Caribbean mixed

11. Findings

12. Age-adjusted incidence rates per 100 000

13. Age-adjusted risk ratios by ethnicity

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

15. “For every age group, the age- specific incidence rates were higher amongst African-Caribbean than among European men.” (page 1217) “For every age group, the age- specific 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) “The threefold relative risk identified in the … study is much higher than that found in the USA.” (page 1218)

16. Study 2

17. 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. Yoav Ben-Shlomo, Simon Evans, Fowzia Ibrahim, Biral Patel, Ken Anson, Frank Chinegwundoh et al. Eur Urol 2007 (in press)

18. 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

19. Sampling & Methods Study design Study design Population- based retrospective cohort study recruiting all cases of prostate cancer diagnosed over a 5-year period.Population- based retrospective cohort study recruiting all cases of prostate cancer diagnosed over a 5-year period. Case definition Case definition Histologically proven or a clinical diagnosis of prostate cancer 5-yr period Pilot study1995–1999 Main data collection 1997–2001

20. Study sites had high proportion of Black residents: Study sites had high proportion of Black residents: North Bristol South West London South East London North East London

21. Findings

22. Total of 2140 incident cases. Total of 2140 incident cases. Ethnic distributions Ethnic 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%)

23. Age-adjusted prostate cancer rates per 100 000

25. Age-adjusted risk ratios by ethnicity

26. Black men vs White men

27. Black Caribbean vs White men

28. Black African vs White men

29. Black African vs Black Caribbean men

30. “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.

31. Conclusion?

32. It is still unclear why the risk of Prostate Cancer is high among the Blacks. It is still unclear why the risk of Prostate Cancer is high among the Blacks. Genetic factors Genetic factors Environmental factors Environmental factors Access to healthcare 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?

33. More studies needed to understand the disproportionate burden of prostate cancer experienced by Black men. More studies needed to understand the disproportionate burden of prostate cancer experienced by Black men.