Abstract
BackgroundAfter the first year of life, cancers are the commonest cause of death in children. Incidence rates vary between ethnic groups, and recent advances in data linkage allow for a more accurate estimation of these variations. Identifying such differences may help identify potential risk or protective factors for certain childhood cancers. This study thus aims to ascertain whether such differences do indeed exist using nationwide data across seven years, as have previously been described in adult cancers.MethodsWe obtained data for all cancer registrations for children (aged 0–14) in England from January 2001 to December 2007. Ethnicity (self-assigned) was established through record linkage to the Hospital Episodes Statistics database or cancer registry data. Cancers were classified morphologically according to the International Classification of Childhood Cancer into four groups – leukaemias; lymphomas; central nervous system; and other solid tumours. Age standardised incidence rates were estimated for each ethnic group, as well as incidence rate ratios comparing each individual ethnic group (Indian, Pakistani, Bangladeshi, Black African, Black Carribean, Chinese) to Whites, adjusting for sex, age and deprivation.ResultsThe majority of children in the study are UK born. Black children (RR = 1.18, 99% CI: 1.01–1.39), and amongst South Asians, Pakistani children (RR = 1.19, 99% CI: 1.02–1.39) appear to have an increased risk of all cancers. There is an increased risk of leukaemia in South Asians (RR = 1.31, 99% CI: 1.08–1.58), and of lymphoma in Black (RR = 1.72, 99% CI: 1.13–2.63) and South Asian children (RR = 1.51, 99% CI: 1.10–2.06). South Asians appear to have a decreased risk of CNS cancers (RR = 0.71, 99% CI: 0.54–0.95).ConclusionsIn the tradition of past migrant studies, such descriptive studies within ethnic minority groups permit a better understanding of disease incidence within the population, but also allow for the generation of hypotheses to begin to understand why such differences might exist. Though a major cause of mortality in this age group, childhood cancer remains a relatively rare disease; however, the methods used here have permitted the first nationwide estimation of childhood cancer by individual ethnic group.
Highlights
After the first year of life, cancers are the commonest cause of death in children
We analysed cancer incidence in gastrointestinal [2], haematological [3], thyroid [4], breast and gynaecological [5], urological [6] and Central nervous system (CNS) [7] malignancies nationwide, looking individually at the difference between British Indians, Pakistanis, Bangladeshis (‘South Asians’), Black Africans, Black Carribeans (‘Blacks’) and Whites. These consistently show differences in incidence between the ethnic groups in many cancers; interestingly, they suggest that these differences – between British Whites and ethnic minorities - can become less marked in some cancers over time [2], in keeping with previous studies in migrant populations [8] and suggesting possible environmental risk and protective factors where such patterns are observed over the space of a few generations
For the analyses presented in this paper, ethnicity was classified as White (White from the 1991 Census and White British from the 2001 Census), Indian, Pakistani, Bangladeshi, Black African, Black Caribbean and Chinese
Summary
After the first year of life, cancers are the commonest cause of death in children. Incidence rates vary between ethnic groups, and recent advances in data linkage allow for a more accurate estimation of these variations. We analysed cancer incidence in gastrointestinal [2], haematological [3], thyroid [4], breast and gynaecological [5], urological [6] and CNS [7] malignancies nationwide, looking individually at the difference between British Indians, Pakistanis, Bangladeshis (‘South Asians’), Black Africans, Black Carribeans (‘Blacks’) and Whites These consistently show differences in incidence between the ethnic groups in many cancers; interestingly, they suggest that these differences – between British Whites and ethnic minorities - can become less marked in some cancers over time [2], in keeping with previous studies in migrant populations [8] and suggesting possible environmental risk and protective factors where such patterns are observed over the space of a few generations
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