The risk of prostate cancer amongst South Asian men in southern England: the PROCESS cohort study

Abstract

OBJECTIVE To reinvestigate whether South Asian men in the UK are at lower risk of being diagnosed with prostate cancer in a UK‐based retrospective cohort study and to examine possible reasons that may explain this. PATIENTS AND METHODS The catchment areas were predefined in four areas of southern England, and age‐ and race‐specific populations for those areas taken from census data. Cases were ascertained through review of multiple hospital sources, while race, other demographic factors, and medical history were determined using questionnaires sent to the men, hospital records review and death certificates. The South Asian group included men of Indian, Bangladeshi and Pakistani origin. RESULTS There was modest evidence of lower prostate cancer rates in South Asian men compared with their White neighbours (age‐adjusted rate ratio 0.81; 95% confidence interval 0.65–1.00). This difference did not reflect less use of prostate‐specific antigen (PSA) testing or differences in clinical features at presentation. CONCLUSION This study provides evidence of a lower incidence of prostate cancer amongst South Asian men living in England, in comparison with their White counterparts. If anything, South Asian men presented with clinical features of earlier disease suggesting that the reduced risk is unlikely to be an artefact of poorer access to health care.

Cancer mortality in ethnic South Asian migrants in England and Wales (1993–2003): patterns in the overall population and in first and subsequent generations

“…These low risks, first noted in the 1970s (Balarajan et al, 1984;Swerdlow et al, 1995), persist nearly 40 years later (Coleman and Salt, 1996), which is consistent with past incidence patterns (Winter et al, 1999;Rastogi et al, 2008;Jack et al, 2009;Metcalfe et al, 2009). Such low cancer rates could be seen as targets to aim for in the general population.…”

Lifestyle factors and prostate-specific antigen (PSA) testing in UK Biobank: Implications for epidemiological research

“…Conversely, factors associated with a lower rate of PSA testing have been associated with a lower risk of prostate cancer, such as obesity [14], diabetes [15], being of Asian ethnic origin [16] and smoking [17]. This suggests that the magnitude of associations observed with risk of total prostate cancer for established risk factors such as black ethnic origin and family history might be exaggerated in recent studies, whereas less well-established associations (such as those between dietary factors and prostate cancer risk), might be due to detection bias.…”

Incidence of prostate cancer in Sri Lanka using cancer registry data and comparisons with the incidence in South Asian men in England

“…The incidence of CaP in South Asian men (Indian, Pakistani, Bangladeshi) living in southern England was 49.55 per 100 000, much higher than their counterparts living in the Asian subcontinent, as shown by the Prostate Cancer in Ethnic Subgroups (PROCESS) study, a population‐based retrospective cohort study [8]. This has been attributed to a variety of diet and environmental factors as well as early detection, reporting bias, lead time and case identification [6].…”