title: Ethnic inequalities in time to diagnosis of cancer: a systematic review.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, UK. tom205@exeter.ac.uk.
authors.forename: Tanimola
authors.initials: T
authors.lastname: Martins
authors.forename: William
authors.initials: W
authors.lastname: Hamilton
authors.forename: Obioha C
authors.initials: OC
authors.lastname: Ukoumunne
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000208:ethnology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D009520:New Zealand; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000208:ethnology; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000208:ethnology; D013997:Time Factors; D006113:United Kingdom