Elsevier

European Urology

Volume 53, Issue 1, January 2008, Pages 99-105
European Urology

Prostate Cancer
The Risk of Prostate Cancer amongst Black Men in the United Kingdom: The PROCESS Cohort Study

https://doi.org/10.1016/j.eururo.2007.02.047Get rights and content

Abstract

Objectives

It is known that African American men have a greater risk of prostate cancer than white men. We investigated whether this was true for first-generation black Caribbean and black African men in the United Kingdom.

Methods

A clinical cohort study design recruiting all cases of prostate cancer diagnosed over a 5-yr period and residing in defined areas of London and Bristol. We calculated the age-standardised incidence rates and relative risk for all black men, and black Caribbean and black African men versus white men.

Results

Black men had higher age-adjusted rates of prostate cancer (166 per 100,000, 95% confidence interval [95%CI], 151–180 per 100,000) than white men (56.4 per 100,000, 95%CI, 53.3–59.5 per 100,000). The relative risks for all black, black Caribbean, and black African men were 3.09 (95%CI, 2.79–3.43; p < 0.0001), 3.19 (95%CI, 2.85–3.56; p < 0.0001) and 2.87 (95%CI, 2.34–3.53; p < 0.0001), respectively. There was no strong evidence that the rates for black Caribbean differed from black African men. The higher risk in black men compared with white men was more apparent in younger age groups (p value for interaction <0.001).

Conclusions

Black men in the United Kingdom have substantially greater risk of developing prostate cancer compared with white men, although this risk is lower than that of black men in the United States. The similar rates in black Caribbean and black African men suggest a common genetic aetiology, although migration may be associated with an increased risk attributable to a gene–environment interaction.

Introduction

In the United Kingdom, prostate cancer is of major public health importance, being the most common cancer in men [1]. The incidence rate has risen steadily over the last 15 years, although the degree to which this rise reflects increased detection and/or a true increase in risk remains uncertain [2], [3].

Data from the United States, Africa, and the Caribbean demonstrate that significant ethnic variations for prostate cancer risk exist [4], [5], [6], [7]. The incidence rate for American black men is estimated to be around 55% greater than that for American white men [4], although this value is likely to be an underestimate because uptake of prostate-specific antigen (PSA) testing is lower in black men [8]. Incidence rates from the Caribbean and Africa are more variable and, in general, much lower than those of black men in the United States, but it is hard to know whether this information reflects a genuine lower risk or a less complete case ascertainment due to limited provision of urologic services and less thorough health information systems. One notable exception was an incidence study [9] from Kingston, Jamaica, which reported that black men had the highest incidence rate in the world at 304 per 100,000 men.

Remarkably little data exist on risk of prostate cancer amongst African Caribbean men in the United Kingdom and how this risk value compares with that of their white counterparts. Migrant studies can be very informative [10]. Because UK black men are largely first-generation migrants, it is uncertain whether they would have rates as high as US black men who have lived in the United States for many generations. Such data would help us understand whether the risk of prostate cancer changes acutely with migration. An analysis of routine mortality data by place of birth did observe elevated prostate mortality rates for both Caribbean and West African immigrants but not those from East Africa [11]. These data are not a direct measure of incidence because mortality is determined by both incidence and case fatality. Studies from the United States suggest that black men may have higher case fatality rates. A large cohort study of men and women in England and Wales (the longitudinal study) found a doubling of the standardised incidence ratios (1971–1989) for people from the Caribbean (2.2; 95%CI, 1.0–4.1) compared with the general population, but this finding was based on only nine cases and wide confidence intervals [12]. A recent audit of prostate cancer cases from East London observed a 3-fold increased risk of prostate cancer amongst black men compared with white men [13]. This smaller study had too few cases to examine whether black men from the Caribbean had any difference in risk compared with black men from the African subcontinent.

Our aim was to establish a UK population-based clinical cohort to derive, for the first time, robust estimates of incidence rates and compare the relative risks of developing prostate cancer among white men and black men of African and Caribbean ancestry.

Section snippets

Methods

We undertook a population-based retrospective cohort study by identifying all incident cases of prostate cancer in prespecified catchment populations: the PRostate Cancer in Ethnic SubgroupS (PROCESS) study. Four areas (North Bristol, South West London, South East London, and North East London) with a relatively high proportion of resident black men were chosen. For each area, we generated a list of all eligible postcodes that covered these areas using the all-fields postcode directory from the

Results

We initially identified 2238 subjects but had to exclude 78 cases who were actually diagnosed outside our eligible time period, 5 men who were not permanent residents within the catchment areas, and 15 men who turned out not to have prostate cancer. This left 2140 incident cases over the 5-yr period (227 cases North Bristol, 456 cases South West London, 710 cases South East London, 747 cases North East London). The ethnic distribution of the cases was as follows: 1315 (61.4%) white, 435 (20.0%)

Discussion

This is the first large study that compares incidence rates of first-generation black migrants from either Africa or the Caribbean with rates of white men in the United Kingdom. Black men have a 3-fold greater risk of developing prostate cancer, and there is little difference between men of Caribbean or African origin. This relative difference is far larger than that seen in the United States because of the lower rate of prostate cancer amongst white men in the United Kingdom. Incidence rates

Conclusions

Our study has demonstrated that black men in the United Kingdom have a much higher relative risk of developing prostate cancer than white men and that this risk is more marked for younger men, although the absolute risk for black men in the United Kingdom is still less than that of African American men. Future research needs to confirm whether black men in the Caribbean and Africa have similar, higher, or lower rates than those for black men in the United Kingdom and United States so that we

Conflicts of interest

None of the authors has any conflict of interest related to this manuscript.

Acknowledgements

We would like to thank all the participants and staff who helped us undertake the study. Special thanks go to Nicola Bentham, Penny Champion, Nicky Collins, Nivea Douglas, Denise Exon, Katrina Hurley, Gaphar Ojetola, Joanna Peixoto, and Cathy Taylor-Hay. We also thank the Office of National Statistics and the South West Cancer Registry for their help.

The study was funded by grants from the Department of Health, UK, Cancer Research Programme, and the Prostate Cancer Charity.

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