Black men at greater risk of prostate cancer
The incidence of prostate cancer is higher in black men than in other ethnic groups. In black American men, the incidence of prostate cancer is approximately 55% greater than in white American men, although even this value is thought to be an underestimate because of differences in the uptake of PSA testing.
A retrospective population-based cohort study from Bristol and London has looked at the risk of prostate cancer in black men in the UK.
The study included all incident cases of prostate cancer in the catchment populations over a five-year period. A total of 2,140 men were studied, of whom 61.4% were white, 20.3% black Caribbean, 4.8% black African, 0.5% black unclassified, 6.0% from other ethnic groups and 7.0% uncoded.
The age-standardised rate of prostate cancer was 56.4 cases per 100,000 for white men and 166 per 100,000 for black men (173 for Caribbean and 139 for African), giving a relative risk of 3.09 (95% CI 2.79–3.43, P=<0.001).
The higher risk in black men was more apparent in younger age groups.
The relative difference is far greater than in the US because of the lower rate of prostate cancer among white men in the UK.
Rates of prostate cancer in black men in Africa and the Caribbean are thought to be much lower. Therefore this study suggests a migrant effect, with migrants in the UK being at greater risk than in their country of origin, and African-American men, who have had more generations of exposure to a Western lifestyle, having a higher risk still.
The authors suggest that epidemiological studies of migrant communities may identify risk factors and enable a primary prevention programme to be developed.
Ben-Shlomo Y, Evans S, Ibrahim F et al. The Risk of Prostate Cancer amongst Black Men in the United Kingdom: The PROCESS Cohort Study. Eur Urol 2008;53:99-105Reviewer
Dr Jonathan Rees
GPwSI Urology, Bristol