Key message:

There are ethnic variations in the age, route of presentation and tumour characteristics of breast cancer patients in England. Patients known to be Black are younger, less likely to be screen-detected and have worse prognosis tumours.

Breast Cancer : Ethnicity - NCIN Data Briefing

Introduction

Ethnicity was available from the Hospital Episode Statistics (HES) dataset for 68% of the 41,482 patients (41,190 female, 292 male; 89% invasive, 11% non-invasive) diagnosed with breast cancer in England in 2006. Reported ethnicity, which is more likely to be recorded for surgically treated patients, was amalgamated into the broad groupings: “White”, “Black”, “Chinese”, “Asian”, “Mixed” and “Other”.

Age at diagnosis and route of presentation

In patients known to be Black, the median age at diagnosis was younger, 50 years compared with 62 years for those known to be White (Table 1). In the screening invitation age group (50-70 years) 56.3% of women known to be White had screen-detected breast cancers compared with 52.1% of women known to be Asian and only 44.6% of women known to be Black.

Table 1: Age at diagnosis and route of presentation for breast cancers diagnosed in England in 2006 according to ethnicity
Ethnicity Grouping Total Cases Age at Diagnosis (Median, Interquartile Range) Women aged 50-70
No. % No. Screen-detected (%)
White 26,807 64.6% 62 (52-72) 14,500 56.3%
Asian 611 1.5% 55 (47-65) 359 52.1%
Black 428 1.0% 50 (43-63) 177 44.6%
Chinese 74 0.2% 53 (48-59) 43 53.5%
Mixed 97 0.2% 52 (43-67) 44 50.0%
Other Ethnicity 222 0.5% 55 (48-66) 122 57.4%
Unknown 13,243 31.9% 63 (53-77) 6,291 54.4%
All England 41,482 100% 62 (52-73) 21,536 55.6%

Patients known to be Black were more likely to have high grade, node positive tumours. Grade was recorded for 93% of the 351 surgically treated invasive breast cancers in Black patients, and nodal status in 63% of these cases. Where data were known, 56% of tumours in Black patients were poor prognosis Grade 3 tumours and 64% had involved lymph nodes (Figure 1). In comparison, for patients known to be White, the proportions of Grade 3 and node positive cancers were lower, at 36% and 38% respectively.

Figure 1: The proportion of surgically treated invasive cancers with poorer prognosis in terms of size, grade and nodal status

The proportion of surgically treated invasive breast cancers with poorer prognosis in terms of size, grade and nodal status

Tumour characteristics according to age at diagnosis and route of presentation

Patients aged 50-70 with screen-detected breast cancers displayed smaller differences in tumour characteristics according to ethnicity than symptomatic patients in the same age group (Figure 2).

Figure 2: The grade of surgically treated invasive cancers according to age and route of presentation

The grade of surgically treated invasive breast cancers according to age and route of presentation

27% of screen-detected cancers in patients known to be White and 25% of screen-detected cancers in patients known to be Black were Grade 1 tumours. 49% of breast cancer patients known to be Black diagnosed in 2006 were aged under 50 and, therefore, were diagnosed before becoming eligible for breast screening. 62% of these patients had Grade 3 tumours (Figure 2) compared with 50% of women known to be White who were aged under 50 at diagnosis.

Further information

This data briefing is based on the All Breast Cancer Report “A UK analysis of all symptomatic and screen detected breast cancers diagnosed in 2006” which includes detailed methodology, a list of data sources and references. Treatment data and adjuvant therapy data are available in this report. The All Breast Cancer Report is available to download from the NCIN website, the NHS Breast Screening website and the WMCIU website. This briefing is one of a series published on the main findings from the 2009 All Breast Cancer Report. Copies of the briefings on Ethnicity and the Elderly are available for download from the NCIN website. The management of non-invasive breast disease is studied in the Sloane Project which is funded by the NHS Breast Screening Programme.

Find out more

The West Midlands Cancer Intelligence Unit is the National Cancer Intelligence Network lead cancer registry for breast cancer.

Other useful resources within the NCIN partnership

Cancer Research UK CancerStats – Key facts and detailed statistics for health professionals.

The National Cancer Intelligence Network (NCIN) is a UK-wide partnership operated by Public Health England. The NCIN coordinates and develops analysis and intelligence to drive improvements in prevention, standards of cancer care and clinical outcomes for cancer patients.