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Cancer risk is higher for people in England with learning disabilities than the general population, especially before age 50 years. This is often due to fewer treatments, a poorer prognosis, and under-investigation, which may have implications for screening.
The study, published in The Lancet Regional Health – Europe, by researchers from The University of Manchester and The Christie NHS Foundation Trust, found that as premature all-cause mortality improves, cancer burden in this population rises disproportionately.
People with learning disabilities were about half as likely to be referred for urgent investigation when they had ‘red flag’ symptoms that could be due to cancer. They were more often diagnosed after the disease had spread, when a cure was not possible, and were less likely to receive surgery, radiotherapy, or systemic anticancer therapy.
Life expectancy after cancer diagnosis was significantly shorter, particularly among those with severe learning disability or Down’s syndrome, with most dying within four years of diagnosis compared with nine years among those without a learning disability.
Several types of cancer are more common in people with learning disabilities
The study, which is the most comprehensive investigation ever carried out, used linked primary care, hospital, and national cancer and death records from England, compared 180,911 individuals with a learning disability to over 3.4 million matched comparators.
In total, 180,911 individuals with a learning disability were matched with 3,405,467 controls. Outcomes included urgent suspected cancer (USC) referrals, cancer diagnoses, treatment within six months, and overall survival (OS) post-diagnosis.
The study also found that several cancers were more common among people with learning disabilities. Rates of sarcoma were around twice as high, cancers of the central nervous system were three and a half times higher, testicular cancer was twice as high, and uterine cancer was about 70% higher compared with the general population.
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While some cancers, including melanoma, breast and prostate cancer were less common among people with learning disabilities, those affected had up to a fourfold higher risk of death after diagnosis, highlighting possible delays in diagnosis and inequities in access to timely and effective treatment.
Cancer risk is high at a younger age
The research team also found that people with learning disabilities were over 70% more likely to develop cancer before the age of 50. This pattern was especially strong for nervous system, uterine, ovarian and digestive tract cancers. Oesophageal cancer in the under-50s was more than five-fold higher in those with a learning disability.
Lead author Dr Oliver Kennedy, Clinical Lecturer at The University of Manchester and The Christie, said: “We already know that people with a learning disability face poorer health outcomes, but the burden of cancer in this population is poorly understood.
“That is why this study, the most comprehensive population-based investigation of cancer in people with a learning disability, is so crucial to understand the immense challenges this vulnerable population group face in cancer care. There is an urgent need for effective strategies to improve cancer detection and care”
Principal Investigator Prof Darren Ashcroft from The University of Manchester and Director of the NIHR Greater Manchester Patient Safety Research Collaboration (GM PSRC), added: “People with a learning disability frequently encounter barriers to healthcare access, such as communication difficulties and diagnostic overshadowing, where clinicians might attribute new symptoms to an existing diagnosis instead of investigating other possible causes.
“These contribute to poorer health outcomes in general. On average, adults with a learning disability die 19–23 years earlier and it is widely accepted that 42% of deaths are considered preventable. This study highlights critical gaps and persistent uncertainties in cancer care for people with a learning disability that merit further investigation.”
