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Racial differences in PSA screening interval and stage at diagnosis

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Abstract

Objectives

This study examined PSA screening interval of black and white men aged 65 or older and its association with prostate cancer stage at diagnosis.

Methods

SEER-Medicare data were examined for 18,067 black and white men diagnosed with prostate cancer between 1994 and 2002. Logistic regression was used to assess the association between race, PSA screening interval, and stage at diagnosis. Analysis also controlled for age, marital status, comorbidity, diagnosis year, geographic region, income, and receipt of surgery.

Results

Compared to whites, blacks diagnosed with prostate cancer were more likely to have had a longer PSA screening interval prior to diagnosis, including a greater likelihood of no pre-diagnosis use of PSA screening. Controlling for PSA screening interval was associated with a reduction in blacks’ relative odds of being diagnosed with advanced (stage III or IV) prostate cancer, to a point that the stage at diagnosis was not statistically different from that of whites (OR=1.12, 95% CI=0.98–1.29). Longer intra-PSA intervals were systematically associated with greater odds of diagnosis with advanced disease.

Conclusions

More frequent or systematic PSA screening may be a pathway to reducing racial differences in prostate cancer stage at diagnosis, and, by extension, mortality.

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References

  1. American Cancer Society (2009) Cancer facts & figures 2009. American Cancer Society, Atlanta

  2. American Cancer Society (2009) Cancer facts and figures for African Americans, 2009-10. American Cancer Society, Atlanta

  3. Institute of Medicine (2003) Unequal treatment: confronting racial and ethnic disparities in healthcare. National Academies Press, Washington DC

  4. Institute of Medicine (1999) The unequal burden of cancer: as assessment of NIH research and programs for ethnic minorities and the medically underserved. National Academies Press, Washington DC

  5. Bach PB, Cramer LD, Warren JL, Begg CB (1999) Racial differences in the treatment of early-stage lung cancer. N Engl J Med 341(16):1198–1205

    Article  CAS  PubMed  Google Scholar 

  6. Field TS, Buist DS, Doubeni C et al. (2005) Disparities and survival among breast cancer patients. J Natl Cancer Inst Monogr (35):88–95

  7. Harlan L, Brawley O, Pommerenke F, Wali P, Kramer B (1995) Geographic, age, and racial variation in the treatment of local/regional carcinoma of the prostate. J Clin Oncol 13(1):93–100

    CAS  PubMed  Google Scholar 

  8. Gilligan T, Wang PS, Levin R, Kantoff PW, Avorn J (2004) Racial differences in screening for prostate cancer in the elderly. Arch Intern Med 164(17):1858–1864

    Article  PubMed  Google Scholar 

  9. Giovannucci E, Stampfer MJ, Krithivas K et al (1997) The CAG repeat within the androgen receptor gene and its relationship to prostate cancer. Proc Natl Acad Sci USA 94(7):3320–3323

    Article  CAS  PubMed  Google Scholar 

  10. Hayes RB, Ziegler RG, Gridley G et al (1999) Dietary factors and risks for prostate cancer among blacks and whites in the United States. Cancer Epidemiol Biomarkers Prev 8(1):25–34

    CAS  PubMed  Google Scholar 

  11. Lichtenstein P, Holm NV, Verkasalo PK et al (2000) Environmental and heritable factors in the causation of cancer–analyses of cohorts of twins from Sweden, Denmark, and Finland. N Engl J Med 343(2):78–85

    Article  CAS  PubMed  Google Scholar 

  12. Moul JW, Sesterhenn IA, Connelly RR et al (1995) Prostate-specific antigen values at the time of prostate cancer diagnosis in African-American men. JAMA 274(16):1277–1281

    Article  CAS  PubMed  Google Scholar 

  13. Johansson JE, Holmberg L, Johansson S, Bergstrom R, Adami HO (1997) Fifteen-year survival in prostate cancer. A prospective, population-based study in Sweden. JAMA 277(6):467–471

    Article  CAS  PubMed  Google Scholar 

  14. Jonsson E, Sigbjarnarson HP, Tomasson J et al (2006) Adenocarcinoma of the prostate in Iceland: a population-based study of stage, Gleason grade, treatment and long-term survival in males diagnosed between 1983 and 1987. Scand J Urol Nephrol 40(4):265–271

    Article  CAS  PubMed  Google Scholar 

  15. Tabar L, Fagerberg CJ, Gad A et al (1985) Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the breast cancer screening working group of the Swedish national board of health and welfare. Lancet 1(8433):829–832

    Article  CAS  PubMed  Google Scholar 

  16. Mandel JS, Bond JH, Church TR et al (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med 328(19):1365–1371

    Article  CAS  PubMed  Google Scholar 

  17. Laara E, Day NE, Hakama M (1987) Trends in mortality from cervical cancer in the Nordic countries: association with organised screening programmes. Lancet 1(8544):1247–1249

    CAS  PubMed  Google Scholar 

  18. Amling CL (2006) Prostate-specific antigen and detection of prostate cancer: what have we learned and what should we recommend for screening? Curr Treat Options Oncol 7(5):337–345

    Article  PubMed  Google Scholar 

  19. Agalliu I, Weiss NS, Lin DW, Stanford JL (2007) Prostate cancer mortality in relation to screening by prostate-specific antigen testing and digital rectal examination: a population-based study in middle-aged men. Cancer Causes Control 18(9):931–937

    Article  PubMed  Google Scholar 

  20. Weinmann S, Richert-Boe K, Glass AG, Weiss NS (2004) Prostate cancer screening and mortality: a case-control study (United States). Cancer Causes Control 15(2):133–138

    Article  PubMed  Google Scholar 

  21. Oberaigner W, Horninger W, Klocker H, Schonitzer D, Stuhlinger W, Bartsch G (2006) Reduction of prostate cancer mortality in Tyrol, Austria, after introduction of prostate-specific antigen testing. Am J Epidemiol 164(4):376–384

    Article  PubMed  Google Scholar 

  22. Andriole GL, Crawford ED, Grubb RL III et al (2009) Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 360(13):1310–1319

    Article  CAS  PubMed  Google Scholar 

  23. Schroder FH, Hugosson J, Roobol MJ et al (2009) Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 360(13):1320–1328

    Article  PubMed  Google Scholar 

  24. Smith DS, Catalona WJ, Herschman JD (1996) Longitudinal screening for prostate cancer with prostate-specific antigen. JAMA 276(16):1309–1315

    Article  CAS  PubMed  Google Scholar 

  25. Gilliland FD, Hunt WC, Key CR (1996) Improving survival for patients with prostate cancer diagnosed in the prostate-specific antigen era. Urology 48(1):67–71

    Article  CAS  PubMed  Google Scholar 

  26. Hugosson J, Aus G, Lilja H, Lodding P, Pihl CG (2004) Results of a randomized, population-based study of biennial screening using serum prostate-specific antigen measurement to detect prostate carcinoma. Cancer 100(7):1397–1405

    Article  PubMed  Google Scholar 

  27. Ung JO, Richie JP, Chen MH, Renshaw AA, D’Amico AV (2002) Evolution of the presentation and pathologic and biochemical outcomes after radical prostatectomy for patients with clinically localized prostate cancer diagnosed during the PSA era. Urology 60(3):458–463

    Article  PubMed  Google Scholar 

  28. Virnig BA, Baxter NN, Habermann EB, Feldman RD, Bradley CJ (2009) A matter of race: early-versus late-stage cancer diagnosis. Health Aff (Millwood) 28(1):160–168

    Article  Google Scholar 

  29. Hugosson J, Aus G, Bergdahl S et al (2003) Population-based screening for prostate cancer by measuring free and total serum prostate-specific antigen in Sweden. BJU Int 92(Suppl 2):39–43

    Article  PubMed  Google Scholar 

  30. Kundu SD, Grubb RL, Roehl KA, Antenor JA, Han M, Catalona WJ (2005) Delays in cancer detection using 2 and 4-year screening intervals for prostate cancer screening with initial prostate specific antigen less than 2 ng/ml. J Urol 173(4):1116–1120

    Article  PubMed  Google Scholar 

  31. Warren JL, Klabunde CN, Schrag D et al (2002) Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 40:3–18

    Google Scholar 

  32. Fritz A, Ries L (eds) (1998) The SEER program code manual, 3rd edn. National Cancer Institute, Bethesda, MD

    Google Scholar 

  33. Yao SL, Lu-Yao G (2001) Interval after prostate specific antigen testing and subsequent risk of incurable prostate cancer. J Urol 166:861–865

    Article  CAS  PubMed  Google Scholar 

  34. Klabunde CN, Potosky AL, Legler JM, Warren JL (2000) Development of a comorbidity index using physician claims data. J.Clin Epidemiol 53:1258–1267

    Article  CAS  PubMed  Google Scholar 

  35. Barry MJ (2009) Screening for prostate cancer—the controversy that refuses to die. NEJM 360(13):1351–1354

    Article  CAS  PubMed  Google Scholar 

  36. Zoorob R, Anderson R, Cefalu C, Sidani M (2001) Cancer screening guidelines. Am Fam Physician 63(6):1101–1112

    CAS  PubMed  Google Scholar 

  37. Carpenter WR, Godley PA, Finnegan T, Talcott JA, Clark JA, Mishel M, Schroeder JC, Bensen JT, Su JL, Fontham ETH, Mohler JL (2009) Racial differences in the roles of trust, regular source of patient care, and screening and treatment utilization among individuals with prostate cancer. Cancer 155(21):5048–5059

    Article  Google Scholar 

  38. Talcott JA, Spain P, Clark JA, Carpenter WR, Do YK, Hamilton RJ, Galanko JA, Jackman A, Godley PA (2007) Hidden barriers between knowledge and behavior: the North Carolina prostate cancer screening and treatment experience. Cancer 109(8):1599–1606

    Article  PubMed  Google Scholar 

  39. Albain KS, Unger JM, Crowley JJ, Coltman CA Jr, Hershman DL (2009) Racial disparities in cancer survival among randomized clinical trials patients of the Southwest oncology group. JNCI 101(14):984–992

    PubMed  Google Scholar 

  40. Lacher DA, Thompson TD, Hughes JP, Saraiya M (2006) Total, free, and percent free prostate-specific antigen levels among US men, 2001–04. Adv Data 379:1–12

    PubMed  Google Scholar 

  41. Efstathiou JA, Chen MH, Catalona WJ et al (2006) Prostate-specific antigen-based serial screening may decrease prostate cancer-specific mortality. Urology 68(2):342–347

    Article  PubMed  Google Scholar 

  42. Ulmert D, Cronin AM, Bjork T et al (2008) Prostate-specific antigen at or before age 50 as a predictor of advanced prostate cancer diagnosed up to 25 years later: a case-control study. BMC Med 6:6

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to acknowledge and thank Anna P. Schenck, PhD, and Sharon Peacock, MS, from the Carolinas Center for Medical Excellence for their expertise and assistance in preparing the data and informing the approach to this analysis. The study was funded by the DoD CDMRP contract W81XWH-05-1-0208 (grant PC040907) and contract W81XWH-07-1-0350 (grant PC060224). Shaw investigators were also funded in part by the National Institutes of Health National Center on Minority Health and Health Disparities grant # P60 MD000239 and National Center for Research Resources grant #C06 RR020139 and Department of Health and Human Services Agency for Healthcare Research and Quality grant R24 HS013353. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. This study was reviewed and approved by the University of North Carolina Institutional Review Board (IRB #09-1154).

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Authors and Affiliations

  1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina (UNC), 1102F McGavran Greenberg Hall; CB 7411, Chapel Hill, NC, 27599, USA

    William R. Carpenter & Paul A. Godley

  2. UNC Lineberger Comprehensive Cancer Center, UNC Chapel Hill, Chapel Hill, NC, USA

    William R. Carpenter, Sara E. Wobker & Paul A. Godley

  3. UNC Cecil G. Sheps Center for Health Services Research, Raleigh, NC, USA

    William R. Carpenter & Paul A. Godley

  4. North Carolina Comprehensive Cancer Program, Raleigh, NC, USA

    William R. Carpenter

  5. Institute for Health, Social and Community Research, Shaw University, Raleigh, NC, USA

    William R. Carpenter, Daniel L. Howard, Yhenneko J. Taylor & Louie E. Ross

  6. Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Paul A. Godley

Authors
  1. William R. Carpenter
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  2. Daniel L. Howard
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  3. Yhenneko J. Taylor
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  4. Louie E. Ross
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  5. Sara E. Wobker
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  6. Paul A. Godley
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Corresponding author

Correspondence to William R. Carpenter.

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Carpenter, W.R., Howard, D.L., Taylor, Y.J. et al. Racial differences in PSA screening interval and stage at diagnosis. Cancer Causes Control 21, 1071–1080 (2010). https://doi.org/10.1007/s10552-010-9535-4

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  • DOI: https://doi.org/10.1007/s10552-010-9535-4

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