Racial Disparities in Head and Neck Cancer Diagnosis and Surgical Outcomes in the UK: A Retrospective Cohort Analysis
Approved Research ID: 91747
Approval date: August 25th 2022
Socioeconomic and racial/ethnic disparities in head and neck cancer (HNC) have been documented in the UK for decades. However, the vast majority of studies focus on Caucasian versus Black populations, and very little data exists regarding other ethnicities, especially Asians. We propose a 3-year proof of concept retrospective study to assess racial disparities in HNC diagnosis, risk factors, treatment outcome, risk of recurrence and outcome of palliative treatment using the large datasets contained within the UK Biobank (UKBB). The UKBB contains in-depth genetic and health information on >500,000 UK adults recruited between 2006-2012. The study population includes around 10,000 British Asian and 8,000 Black ethnicity participants. The study population will include patients diagnosed with HNC prior to (n=859) and following UKBB recruitment (n=253) and will be compared with a non-HNC population, statistically adjusting for potential confounders. The well-characterised UKBB population will enable more specific analysis, including non-White/Black ethnicity populations, who are poorly represented in the Cancer Genome Atlas (TCGA) database, which only contains the genetic information of HNC tumours from White (n=448) and Black or African American (n=47) patients. We have 3 main objectives:
Objective 1) HNC risk associations: Ethnicity, along with biochemical markers, medical co-morbidities (e.g. cardiovascular disease) will be investigated in HNC/non-HNC patients and stratified by body mass index (BMI) and ethnicity to identify whether risk thresholds vary in different populations. Expected milestone: development of personalised risk scores to aid the identification of patients at increased risk of HNC.
Objective 2) Pathways to diagnosis: The UKBB Hospital Episode Statistics (HES)-linked and questionnaire data (including diet/food, cognitive function, digestive and mental health) will be utilised to explore the impact of social influences, in particular deprivation and medical/mental health co-morbidities, on pathways to diagnosis and survival. Expected milestone: quantification of delays in diagnosis on survival and characteristics of patients at greatest risk of late diagnosis.
Objective 3) HNC genetics: Whole exome/genome sequencing data will be used to explore the previously identified genome-wide HNC risk loci associations with age at diagnosis, ethnicity and other co-morbidities. Additional analyses, including telomere length and mis-match repair gene mutations will be performed. Expected milestone: incidence of genes of interest and known HNC-risk genes in different population groups.
Overall, this study will illuminate factors contributing to racial disparities in HNC cancer diagnosis, paving the way for public engagement initiatives and knowledge transfer through informing NHS England with the ultimate aim of improving cancer survival in this underserved population.