Ethnic inequalities in time to diagnosis of cancer: a systematic review

Abstract

BackgroundMinimising diagnostic delays in cancer may help improve survival. Ethnic minorities have worse outcomes in some cancer types when compared to the majority; this may relate in part to differences during the diagnostic phase. Only a few British studies have specifically explored this relationship, and no synthesis of these exists. The present study aimed to systematically review evidence on ethnic inequalities in cancer diagnosis, focussing on patient and primary care intervals of diagnosis.MethodsSix electronic databases were searched. Included studies were those conducted in the UK or elsewhere (where access to healthcare is comparable to the NHS) and those that described a time element during diagnosis. Study quality was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for cohort studies and synthesis method was narrative.ResultsSeven of 8,520 studies retrieved by our search met the review criteria; six conducted in the UK, and one in New Zealand. Five (including one covering several sites) focused on breast cancer, one on prostate, and one on oesophagogastric cancer. The studies employed different methods of ascertainment and definition of ethnic groups and defined diagnostic delay in a non-standardised way; therefore, narrative synthesis was performed. In breast cancer, three studies reported longer diagnostic intervals among ethnic minorities and two found no evidence of differences by ethnicity. There was some evidence of longer diagnostic and referral intervals among ethnic minorities in oesophagogastric and colorectal cancers, but no evidence of this in prostate, non-Hodgkin’s lymphoma, lung, and ovarian cancers. None of the studies identified shorter patient or primary care intervals in ethnic minorities.ConclusionsExisting studies provide insufficient evidence to confirm or refute ethnic inequalities in diagnostic intervals of cancer. Further studies are necessary to examine common cancer types including those frequently found in ethnic minorities (in addition to those covered here) and using current definitions of intervals in cancer diagnosis.

Breast screening attendance of Aboriginal and Torres Strait Islander women in the Northern Territory of Australia

“…This result, coupled with the earlier finding that Indigenous compared with non‐Indigenous women were more likely to attend BreastScreen for the first and second time in 2015, suggests that Indigenous women are engaging with initial screening in the NT, where culturally and linguistically appropriate strategies have been implemented to meet the needs of Indigenous peoples 8 . However, our results also imply that continued attendance beyond three visits may wane with those for whom English is not the main spoken language, a finding supported by other researchers who have shown that language can be a significant barrier to health for many Indigenous cultures around the world 10,13,33,34 . For example, it is reported that there is no word for cancer in many Indigenous languages, including Australian languages, which immediately presents difficulties when promoting screening 35 .…”

“…In addition, systematic barriers to screening are also evident for Indigenous Australians, including geographic isolation, lack of means of transportation to attend services, and a shortage of culturally competent facilitators to screening 11,12 . Evidence in the US, Canada, Alaska, Pacific Islands, and New Zealand show that Indigenous women are more likely to be underrepresented in breast screening 13–15 and have higher breast cancer mortality rates compared with non‐Indigenous women 14–16 . A similar scenario is reported for Indigenous Australian women who, despite lower breast cancer incidence, have poorer health outcomes and higher rates of death from breast cancer when compared with other Australian women 17 .…”

Complementary and alternative medicine (CAM) use and delays in presentation and diagnosis of breast cancer patients in public hospitals in Malaysia

“…This highlight the importance of symptom appraisal as reported in other studies [5,41,42]. Appraisal is defined as a decision making process [43] which begins when the women discovered an abnormality in their breasts [44].…”

Missed Opportunities for the Diagnosis of Colorectal Cancer

“…There is some evidence to suggest longer CRC diagnostic delay for ethnic minorities [ 20 ], and considerable research to indicate differences in physician-patient communication based on race/ethnicity, including less provision of biomedical information, less psychosocial counseling, and less relationship building with non-White breast cancer patients [ 21 ], as well as less patient-centered communication and less positive affect towards African American patients [ 22 ].…”