University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, UK.
BMC Fam Pract. 2013 Dec 23;14:197. doi: 10.1186/1471-2296-14-197.
Minimising diagnostic delays in cancer may help improve survival. Ethnic minorities have worse outcomes in some cancer types when compared to the majority; this may relate in part to differences during the diagnostic phase. Only a few British studies have specifically explored this relationship, and no synthesis of these exists. The present study aimed to systematically review evidence on ethnic inequalities in cancer diagnosis, focussing on patient and primary care intervals of diagnosis.
Six electronic databases were searched. Included studies were those conducted in the UK or elsewhere (where access to healthcare is comparable to the NHS) and those that described a time element during diagnosis. Study quality was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for cohort studies and synthesis method was narrative.
Seven of 8,520 studies retrieved by our search met the review criteria; six conducted in the UK, and one in New Zealand. Five (including one covering several sites) focused on breast cancer, one on prostate, and one on oesophagogastric cancer. The studies employed different methods of ascertainment and definition of ethnic groups and defined diagnostic delay in a non-standardised way; therefore, narrative synthesis was performed. In breast cancer, three studies reported longer diagnostic intervals among ethnic minorities and two found no evidence of differences by ethnicity. There was some evidence of longer diagnostic and referral intervals among ethnic minorities in oesophagogastric and colorectal cancers, but no evidence of this in prostate, non-Hodgkin's lymphoma, lung, and ovarian cancers. None of the studies identified shorter patient or primary care intervals in ethnic minorities.
Existing studies provide insufficient evidence to confirm or refute ethnic inequalities in diagnostic intervals of cancer. Further studies are necessary to examine common cancer types including those frequently found in ethnic minorities (in addition to those covered here) and using current definitions of intervals in cancer diagnosis.
减少癌症诊断延迟可能有助于提高生存率。与大多数人相比，少数民族在某些癌症类型中的预后更差；这可能部分与诊断阶段的差异有关。只有少数几项英国研究专门探讨了这种关系，而且没有对这些研究进行综合分析。本研究旨在系统地回顾有关癌症诊断中种族不平等的证据，重点关注患者和初级保健诊断间隔。
检索了六个电子数据库。纳入的研究是在英国或其他国家（那里的医疗保健与国民保健制度相似）进行的，并且描述了诊断过程中的时间元素。使用针对队列研究的批判性评估技能计划 (CASP) 检查表评估研究质量，综合方法为叙述性。
我们的搜索共检索到 8520 篇研究，其中 7 篇符合审查标准；其中 6 篇在英国进行，1 篇在新西兰进行。其中 5 篇（包括涵盖多个部位的 1 篇）聚焦于乳腺癌，1 篇聚焦于前列腺癌，1 篇聚焦于食管胃交界癌。这些研究采用了不同的确定和定义种族群体的方法，并且以非标准化的方式定义了诊断延迟；因此，进行了叙述性综合分析。在乳腺癌中，有 3 项研究报告称少数民族的诊断间隔较长，而有 2 项研究未发现种族间存在差异的证据。在食管胃交界癌和结直肠癌中，少数民族的诊断和转诊间隔较长，但在前列腺癌、非霍奇金淋巴瘤、肺癌和卵巢癌中则没有这种情况。这些研究均未发现少数民族的患者或初级保健间隔较短。
现有研究提供的证据不足以证实或反驳癌症诊断间隔中的种族不平等。需要进一步研究以检查常见的癌症类型，包括少数民族中常见的癌症类型（除了这里涵盖的癌症），并使用当前癌症诊断间隔的定义。
