A significant study conducted by researchers from The University of Manchester and The Christie NHS Foundation Trust has uncovered alarming disparities in cancer care for individuals with learning disabilities in England. The findings indicate that these patients are at a greater risk of developing cancer, particularly before the age of 50. The study, published in The Lancet Regional Health—Europe, utilized extensive national datasets, marking it as one of the most comprehensive investigations into this issue to date.
The research analyzed data from 180,911 individuals with learning disabilities, comparing their outcomes to over 3.4 million individuals without such disabilities. The results revealed that people with learning disabilities were approximately half as likely to be referred for urgent investigations when presenting with “red flag” symptoms indicative of cancer. Consequently, many were diagnosed only after the cancer had progressed to an advanced stage, where treatment options were severely limited.
Individuals with learning disabilities also faced significant barriers in accessing timely treatment. They were less likely to receive interventions such as surgery, radiotherapy, or systemic anticancer therapy, leading to a markedly shorter life expectancy following a cancer diagnosis. The study found that those diagnosed with severe learning disabilities or Down syndrome typically lived less than four years after diagnosis, compared to nine years for those without learning disabilities.
Certain cancers were notably more prevalent among individuals with learning disabilities. For instance, the incidence of sarcoma was approximately double that of the general population, while cancers of the central nervous system were found to be three and a half times more common. Testicular cancer rates were also double, and uterine cancer was about 70% more frequent. Although some cancers, like melanoma and breast cancer, were less common, individuals with learning disabilities faced up to a fourfold increase in mortality risk post-diagnosis, underscoring the inequities in cancer care.
The study further revealed that individuals with learning disabilities were more than 70% more likely to develop cancer before the age of 50. This trend was particularly pronounced for cancers related to the nervous system, uterus, ovaries, and digestive tract. Notably, the risk of esophageal cancer in this group was more than five times higher for those under 50.
Lead author Dr. Oliver Kennedy, a Clinical Lecturer at The University of Manchester and The Christie, emphasized the importance of this research. “We already know that people with a learning disability face poorer health outcomes, but the burden of cancer in this population is poorly understood. This study highlights the immense challenges this vulnerable group faces in cancer care. There is an urgent need for effective strategies to improve cancer detection and care,” he stated.
Principal Investigator Prof. Darren Ashcroft, Director of the NIHR Greater Manchester Patient Safety Research Collaboration, noted that individuals with learning disabilities encounter multiple barriers to healthcare access. These include communication difficulties and a phenomenon known as diagnostic overshadowing, where healthcare professionals attribute new symptoms to existing conditions rather than investigating further. These factors contribute to poorer health outcomes, with adults with learning disabilities dying, on average, 19–23 years earlier than their peers. Prof. Ashcroft highlighted that around 42% of these deaths are considered preventable.
Dr. Kennedy expressed concern that many patients with learning disabilities may miss opportunities for early diagnosis due to their reduced likelihood of receiving urgent referrals after presenting with red-flag symptoms. He pointed out that many cancers were diagnosed outside of urgent suspected cancer referral pathways, often at advanced stages.
Jon Sparkes OBE, chief executive of the learning disability charity Mencap, criticized the current state of cancer care for individuals with learning disabilities. “Cancer is the second most common cause of avoidable death among this population. It’s unacceptable that late diagnosis and lack of urgent referrals are costing years of life,” he said. Sparkes called for the NHS to implement priority screening at younger ages and ensure urgent referrals for people known to be at greater risk of certain cancers.
The findings of this research underscore the critical need for improved cancer detection and treatment strategies for individuals with learning disabilities, as highlighted in the publication titled “Cancer diagnoses, referrals, and survival in people with a learning disability in the UK: a population-based, matched cohort study” in The Lancet Regional Health—Europe.
