1. Prostate cancer and ethnicity Luke Hounsome Public Health England ‘Hear me now’ workshop - Birmingham

2. Summary What is the picture on prostate cancer in Birmingham? How does this compare to the whole of England? Does your ethnicity affect your risk and outcomes? 2Prostate cancer and ethnicity – ‘Hear me now’ workshops

3. Where do the data come from? All newly diagnosed cases of cancer are registered by a regional office of the national Cancer Registration Service. Deaths from cancer from the Office for National Statistics. Ethnicity from inpatient hospital record – self reported. At diagnosis many men with prostate cancer do not have an inpatient record so there is lower completeness compared to other cancers. All information in this presentation has been supplied through Public Health England. 3Prostate cancer and ethnicity – ‘Hear me now’ workshops

4. Prostate cancer in Birmingham In 2008-10 combined there were 1,808 new cases of prostate cancer – 603 per year on average. Incidence is higher than the England average. 76% had a recorded ethnicity – of these 79% were white. In 2008-10 combined there were 508 deaths from prostate cancer – 169 per year on average. Mortality is in line with the England average. 98% had a recorded ethnicity – of these 85% were white. The population (based on 2009 ONS estimate) is 67% white, 6% black and 20% asian (Indian, Pakistani, Bangladeshi). One-year relative survival is 97% and five-year relative survival is 89% (this is better than the England average). 4Prostate cancer and ethnicity – ‘Hear me now’ workshops

5. Prostate cancer in Birmingham Prostate cancer accounts for 27% of new cases of cancer in men. More than 1 in 3 of the cancers in Birmingham with no known ethnicity are prostate cancers. 14% of cancer cases in Asian men, but 50% in black men. Prostate cancer accounts for 11% of cancer deaths and 4% of all deaths in men in Birmingham. In black men this is 21% of cancer deaths and 8% of all deaths – higher than the average. In asian men it is 6% of cancer deaths and 1% of all deaths – lower than the average. In deaths for those aged under 75 (premature mortality) the percentages are 6% and 3% respectively. In black men this is 17% of cancer deaths and 6% of all deaths (under 75) – higher than the average. 5Prostate cancer and ethnicity – ‘Hear me now’ workshops

6. Prostate cancer in England In 2008-10 combined there were 102,252 new cases of prostate cancer – 34,084 per year on average. 74% had a recorded ethnicity – of these 94% were white. In 2008-10 combined there were 24.363 deaths from prostate cancer – per year on average. 98% had a recorded ethnicity – of these 99% were white. The population (based on 2009) is 87% white, 3% black and 6% asian (Indian, Pakistani, Bangladeshi). One-year relative survival is 95% and five-year relative survival is 84%. 6Prostate cancer and ethnicity – ‘Hear me now’ workshops

7. Prostate cancer in England Prostate cancer accounts for 26% of new cases of cancer in men in England. 3 in 5 of the cancers in England with no known ethnicity are prostate cancers. 42% of cancers known to be in black men are prostate cancer 18% of cancers known to be in asian men are prostate cancer Prostate cancer accounts for 12% of cancer deaths and 4% of all deaths in men in England. 22% of cancer deaths in black men and 8% of all deaths 8% of cancer deaths in asian men, and 2% of all deaths In deaths for those aged under 75 (premature mortality) the percentages are 7% and 3% respectively. 15% of cancer deaths in black men and 6% of all deaths 5% of cancer deaths in asian men, and 1% of all deaths 7Prostate cancer and ethnicity – ‘Hear me now’ workshops

8. Prostate cancer in England - stage Stage data is only available for 26% of newly diagnosed prostate cancers. The following are expressed as percentage of cases where the stage is known. 8Prostate cancer and ethnicity – ‘Hear me now’ workshops BlackAsianWhiteOtherMixedNot known Localised53% (243) 47% (92) 52% (10,075) 40% (36) 46% (21) 61% (3,800) Locally advanced 17% (79) 24% (46) 15% (2,961) 20% (18) 11% (5) 17% (1,066) Advanced30% (140) 29% (56) 32% (6,182) 39% (445) 43% (20) 22% (1,384)

9. Prostate cancer incidence in England – by age 9Prostate cancer and ethnicity – ‘Hear me now’ workshops

10. Prostate cancer incidence in England – age adjusted 10Prostate cancer and ethnicity – ‘Hear me now’ workshops

11. Prostate cancer mortality in England – by age 11Prostate cancer and ethnicity – ‘Hear me now’ workshops

12. Prostate cancer mortality in England – age adjusted 12Prostate cancer and ethnicity – ‘Hear me now’ workshops

13. Prostate cancer in England 13Prostate cancer and ethnicity – ‘Hear me now’ workshops What do all these numbers/graphs mean? The risk of getting prostate cancer is over double (RR 2.3) for black men, but nearly half (RR 0.54) for asian men, compared to white men. The risk of dying from prostate cancer is about double (RR 2.06) for black men, and under half (RR 0.46) for asian men, compared to white men. What about the individual? The lifetime risk of getting prostate cancer is 27% for a black man, 7% for an asian man, and 12% for a white man. The lifetime risk of dying from prostate cancer is 8% for a black man, 2% for an asian man, and 4% for a white man.

14. Prostate cancer survival in England – all stages 14Prostate cancer and ethnicity – ‘Hear me now’ workshops

15. Prostate cancer survival in England – localised 15Prostate cancer and ethnicity – ‘Hear me now’ workshops

16. Prostate cancer survival in England – locally advanced 16Prostate cancer and ethnicity – ‘Hear me now’ workshops

17. Prostate cancer survival in England – advanced 17Prostate cancer and ethnicity – ‘Hear me now’ workshops

18. Prostate cancer in England 18Prostate cancer and ethnicity – ‘Hear me now’ workshops Survival from prostate cancer is high, and (given the amount of data we have) does not appear to vary by ethnicity. Survival is primarily driven by how advanced the cancer is at diagnosis. Difference between localised and advanced at one year is about 20% Difference at five years is about 55% Difference at ten years is nearly 80%