DiagnosticEDI Tackling inequality with research

A recent integrated health needs assessment for North West London highlighted health inequalities across our boroughs in part driven by cancer diagnoses. Given our community has 8.2% population of Black residents who are at greater risk of
developing some cancers, we are actively researching new ways to diagnose these cancers.

Black men have twice the lifetime risk of developing prostate cancer compared to the general population. The Imperial BRC supported research to improve prostate cancer screening. PROSTAGRAM recruited over 400 men and demonstrated that a
short, 15-minute MRI detected most clinically significant cancers, while standard PSA testing (a blood test that measures prostate-specific antigen) missed seven significant cancers; particularly important for black men given their higher risk. BRC
infrastructure and funding were instrumental in achieving recruitment targets and completing the trial ahead of schedule. This has directly led to the £42m TRANSFORM trial a partnership between the BRC, Prostate Cancer UK and Movember. Despite the increased risk, black men have historically been underrepresented in screening trials and so inclusive recruitment is being explicitly included in trial design. In stage 1, TRANSFORM has committed to ensuring at least one in ten men invited were Black. However, following an £18m Government investment on the strength of early studies, all eligible Black men aged 45–74 will be invited, ensuring evidence on screening is relevant to those at greatest risk.

Human T-cell Lymphotropic Virus type 1 (HTLV-1) is a neglected infection associated with poverty and health inequity disproportionately affecting people of Black Caribbean, West and Central Africa and Brazilian origin. It can cause adult T cell
Leukaemia (ATLL), a form of blood cancer, in 5% of carriers but in 20% of carriers following early life infection and myelopathy, a progressive neurological disorder. BRC-supported research has identified biomarkers for HTLV-1-associated
disease have been translated into clinical practice and are now used to deliver patient care according to risk and early diagnosis. We have shown that targeted antenatal screening and prevention could prevent an estimated 58 infant infections
each year, reducing mother-to-child transmission, long-term health consequences and NHS costs. This work contributed to the UK National Screening Committee Service specification for the HTLV-1 (2026) moving towards a more selective, risk based approach to antenatal screening. It has also had major international impact including introduction of universal HTLV-1 antenatal screening in Brazil, the country with the highest number of people living with HTLV-1.