The most comprehensive study ever conducted of lung cancer diagnosis in England has revealed significant disparities between ethnic groups and striking evidence that people living in the most deprived areas were diagnosed with lung cancer at twice the rate of those in affluent areas.
Lung cancer is a leading cause of death world-wide, responsible for over 1.8 million deaths each year. The UK also faces a significant burden, with lung cancer accounting for more than 35,000 deaths each year.
The study, published in The Lancet Regional Health – Europe, which is the largest of its kind analysed health records of over 17.5 million people and more than 84,000 lung cancer cases, found that Bangladeshi men had the highest rates of lung cancer, while people from the most deprived areas developed the disease at twice the rate of those from affluent areas.
Among those who developed lung cancer, people from deprived areas had a 35% higher risk of being diagnosed with more aggressive forms of the disease.
Researchers from Oxford's Nuffield Department of Primary Care Health Sciences found clear evidence that different ethnic groups show distinct patterns of lung cancer types, with important implications for screening and early detection.
Professor Julia Hippisley-Cox, senior author of the study, said: "This research provides the strongest evidence yet of how your ethnic background and social circumstances affect both your risk of developing lung cancer and the type of cancer you may develop. These findings are particularly timely as the NHS rolls out its targeted lung cancer screening programme."
Key findings include:
- Bangladeshi men showed the highest lung cancer rates, followed by White, Chinese and Caribbean men
- Women and people from Indian, Caribbean, Black African, Chinese and other Asian backgrounds were twice as likely to be diagnosed with adenocarcinoma, one of the most common types of lung cancer
- Lung cancer occurred twice as frequently in the most deprived areas compared to the least deprived areas (215 vs 94 cases per 100,000 person-years for men; 147 vs 62 for women)
- Men and current smokers were more likely to be diagnosed at later stages of cancer than women and non-smokers
Dr Daniel Tzu-Hsuan Chen, who led the research, said: "For the first time, we can see clear patterns in how lung cancer affects different communities across England. This isn't just about smoking – our research shows that ethnic background and social circumstances play crucial roles in both cancer risk and how the disease develops."
The findings come at a crucial time as the NHS rolls out its Targeted Lung Health Check Programme across England. This screening initiative currently focuses on areas with high lung cancer rates and social deprivation, aiming to detect cancer earlier when it's more treatable. The new research could help ensure these vital health checks reach those most at risk and are tailored to different community needs.
Early detection through targeted screening could significantly reduce treatment costs for the NHS, as late-stage cancer care is considerably more expensive. More importantly, catching cancer earlier could save thousands of lives each year.
The research highlights how social factors like poverty and healthcare access affect cancer outcomes. “We need to ensure our cancer services are reaching all communities effectively and that everyone has the same opportunity for early diagnosis, regardless of their background or where they live,” said Professor Hippisley-Cox. "But tackling these disparities isn't just about lung cancer, when we address these fundamental inequalities in healthcare access and social deprivation, we can improve health outcomes across many conditions. This research helps make the case for wider action on health inequalities."
Publication details:
Ethnic disparities in lung cancer incidence and differences in diagnostic characteristics: a population-based cohort study in England
Daniel Tzu-Hsuan Chen; Jennifer Hirst; Carol A.C. Coupland; Weiqi Liao; David R. Baldwin; Julia Hippisley-Cox
https://doi.org/10.1016/j.lanepe.2024.101124