A NEW population-level study conducted in the English National Health Service (NHS) has found significant ethnic disparities in the diagnosis of colorectal cancer (CRC), with variations in the stage of diagnosis, age at onset, and route to diagnosis across different ethnic groups. Published in Gut, the research highlights inequalities that may influence outcomes and access to early detection services.
The study, which analysed data from the COloRECTal Cancer Data Repository, included individuals diagnosed with CRC between 2012 and 2017. Researchers aimed to assess the impact of ethnicity on early-onset CRC (diagnosis before age 50), the likelihood of diagnosis through emergency routes, and the probability of being diagnosed at an advanced stage (stage IV).
Findings revealed that early-onset CRC was significantly more common in non-white ethnic groups. While only 5.5% of white patients were diagnosed with CRC before the age of 50, the rates were notably higher in Asian (17.9%), Black (15.5%), and mixed/multiple ethnic groups (21.8%).
The study also found differences in how CRC was diagnosed. Patients from Asian, Black, and other ethnic backgrounds were less likely to be diagnosed through the NHS’s urgent two-week wait referral system compared to white patients. Specifically, Asians (OR 0.84), Blacks (OR 0.86), and those in the “other” ethnic group (OR 0.81) had lower odds of receiving a diagnosis through this early-detection pathway. However, individuals from the Asian ethnic group were also less likely to be diagnosed via emergency hospital admission, suggesting potential differences in healthcare-seeking behaviour or referral patterns.
Regarding disease progression at the time of diagnosis, individuals from the Asian ethnic group had a lower likelihood of being diagnosed at stage IV compared to white patients (OR 0.82). This suggests that while Asian patients may not access two-week wait referrals as frequently, they may still be diagnosed earlier than white patients, potentially due to alternative diagnostic pathways.
The findings underscore the importance of improving access to CRC screening and diagnostic services across all ethnic groups. The disparities in diagnosis routes and disease stage at presentation indicate that targeted public health interventions may be needed to ensure equitable cancer detection and treatment.
Aleksandra Zurowska, EMJ
Reference
Birch RJ et al. Inequalities in colorectal cancer diagnosis by ethnic group: a population-level study in the English National Health Service. BMJ Open Gastroenterology. 2025;DOI: 10.1136/bmjgast-2024-001629.
