Ethnicity and the epidemiology of skin cancer incidence: a national retrospective population-based study in England, 2013-20.
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BACKGROUND: Skin cancers primarily affect people of White ethnicity and with lighter skin tones, but people of other ethnicities may face diagnostic delays and experience higher mortality, reflecting existing inequities in healthcare. OBJECTIVES: To show incidence data from the National Disease Registration Service (NDRS) cancer registry in England for skin cancers, stratified by the seven broad ethnic groups. METHODS: We used data from the NDRS from 2013 to 2020 to analyse melanoma, acral lentiginous melanoma (ALM), basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), cutaneous T-cell lymphoma and Kaposi sarcoma (KS). Tumour records were linked to datasets including census population data, Office for National Statistics (ONS) mortality data, Index of Multiple Deprivation and Hospital Episode Statistics. Ethnicity data were grouped into seven standardized broad ONS categories: White, Asian, Chinese, Black, Mixed, Other and Unknown. European age-standardized rates (EASRs) were calculated using the 2013 European Standard Population and are reported per 100 000 person-years (PY). RESULTS: Ethnic diversity in England increased between the 2011 and 2021 censuses. Proportions of cases with 'Unknown' ethnicity with registry data ranged from 19.2% for BCC to 5.0% for ALM. The EASR (with 95% confidence interval) of melanoma was 33 times higher in the White group (27.3, 27.1-27.5) than in the Asian group (0.82, 0.67-0.99) and 16 times higher in the White than in the Black ethnic group (1.67, 1.37-2.01). Similarly, cSCC was 14 times more common in the White group (61.8, 61.5-62.0) than in the Asian group (4.55, 4.15-4.97) and 13 times more common in the White than in the Black ethnic group (4.73, 4.17-5.34). BCC was 26 times more common in the White group (154, 153-154) than in the Asian group (5.59, 5.16-6.04) and 27 times more common in the White than in the Black ethnic group (5.98, 5.35-6.65). However, the EASR for ALM was highest in the Black ethnic group. ALM was less likely to be referred along the Urgent Suspected Cancer pathway and was more likely to present at a later stage than melanoma overall. The EASR for KS was significantly higher in the Other and Black ethnic groups. CONCLUSIONS: A lack of high-quality published ethnicity data hampers our understanding of health disparities. These findings emphasize the need for better collection of ethnicity data and regular audits to better understand and address the needs of populations underserved by healthcare resources.