Cancer in minority ethnic populations: priorities from epidemiological data

The aim of this paper is to review the literature on the frequency of cancers to develop priorities for cancer policy, prevention, services and research for black and minority ethnic populations in Britain. Data on populations originating in the Indian sub-continent, and Caribbean and African Commonwealth were extracted from published works. Cancers were ranked (top seven) on the basis of the number of cases, actual frequency, and also on relative frequency (SMR, SRR, PMR). Cancer was found to be a common cause of death. For example, during 1979-83 the proportion of deaths resulting from neoplasms in immigrants living in England and Wales was 11% for Indian and African men aged 20-49, and 19% for Caribbeans. The corresponding proportions were higher among women. The pattern of cancer depended on the method used to assess rankings. On the basis of the number of cases the top 3 ranking cancers for adults were breast, long and neoplasms of the lymphatic system. Based on SMR's cancer of the gallbladder, liver and oral cavity ranked amongst the top 3 for adults. For children the top ranking cancers were acute lymphoblastic leukaemia, central nervous system tumours and neuroblastoma. Variations by ethnic group were more evident in the rankings of relative frequency than in rankings based on numbers of cases. In conclusion, the most common and preventable cancers among minority ethnic populations were the same as those for the general population. The different cancer pattern based on SMRs highlight additional needs and provide potential models for research into understanding the causes of these cancers. Health services policy and practice should ensure that the common and preventable cancers take priority over rare cancers and those for which there is no effective treatment or prevention. Priorities for policy, prevention, clinical care and research should be set separately, for they differ.