Black-white differences in the stage at presentation of prostate cancer in the district of columbia

Ndubuisi, Samuel C.; Kofie, Vincent Y; Andoh, Jacob Y.; Schwartz, Eugene

doi:10.1016/s0090-4295(99)80162-9

Cited by 67 publications

(29 citation statements)

References 11 publications

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“…We also observed that African-Americans were disadvantaged in terms of survival. Unlike other studies (22,23), the current study was able to explain more than half of the observed race difference in stage at diagnosis, rendering it not statistically significant. However, adjustment for individual explanatory factors produced relatively modest modifications of the race-stage association, indicating that this is a complex relationship that cannot be explained by any single factor.…”

Section: Discussioncontrasting

confidence: 99%

“…Consistent with previous work (20)(21)(22)(23)(24)(25)(26), we observed that African-Americans were twice as likely as Whites to be diagnosed at a more advanced stage of disease. We also observed that African-Americans were disadvantaged in terms of survival.…”

Section: Discussionsupporting

confidence: 91%

“…We observed that education level had a meaningful impact on the race-stage relation, but consistent with previous reports (21)(22)(23)(24)28), adjustments for race differences in education level did not entirely explain the stage disparity. Despite the availability of a number of factors hypothesized to mediate the effect of education (e.g., medical care and lifestyle factors), we were unable to identify the precise mechanism through which education operates.…”

Section: Discussionsupporting

confidence: 87%

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Explaining the Race Difference in Prostate Cancer Stage at Diagnosis

Jones

Araujo

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Prostate cancer is the most frequently diagnosed cancer in males in the United States, accounting for an estimated 186,320 new cases in 2008. There are striking racial or ethnic differences in prostate cancer incidence and mortality rates in the United States, with Black males 1.6 times more likely to be diagnosed and 2.4 times more likely to die with prostate cancer than Whites. Stage at diagnosis is a key prognostic factor for prostate cancer survival, with African-Americans generally diagnosed at a more advanced stage. To identify factors that explain the race-stage disparity in prostate cancer, we conducted a population-based casecase study of 251 African-American (46%) and White (54%) prostate cancer cases diagnosed in Connecticut between January 1987 and October 1990. Multivariate logistic regression was used to identify potential explanatory factors, including clinical, sociodemographic, medical care, insurance, digital rectal examination screening history, and lifestyle factors. Cox proportional hazards models assessed the impact of study variables on race differences in long-term survival. Modifiable factors such as screening practice and sociodemographic factors accounted for >60% of the race difference in prostate cancer stage at diagnosis. Histologic grade (Gleason score) accounted for comparatively less. Survival analyses confirmed the importance of tumor characteristics, education, and insurance in explaining observed race differences in survival. Although cases were identified before the widespread use of prostate-specific antigen (PSA) screening, the results should also be relevant to countries that have large underserved populations and/or disparities in access to medical care and cancer screening. (Cancer Epidemiol Biomarkers Prev 2008;17(10):2825 -34)

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 87%

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Explaining the Race Difference in Prostate Cancer Stage at Diagnosis

Jones

Araujo

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…In addition, African Americans have 2.4 times the mortality of Whites (7). Poorer survival may reflect stage-at-diagnosis issues (8,9), disease biology (10,11), or other environmental or social factors (12) and African American men are more likely to be detected with advanced (7,13,14) or metastatic cancers (9); disparities are more pronounced for more advanced tumors (15,16).…”

Section: Introductionmentioning

confidence: 99%

An Object Lesson: Source Determines the Relations That Trait Anxiety, Prostate Cancer Worry, and Screening Fear Hold with Prostate Screening Frequency

Consedine

Adjei²,

Ramírez³

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Fears regarding prostate cancer and the associated screening are widespread. However, the relations between anxiety, cancer worry, and screening fear and screening behavior are complex, because anxieties stemming from different sources have different effects on behavior. In differentiating among anxieties from different sources (trait anxiety, cancer worry, and screening fear), we expected that cancer worry would be associated with more frequent screening, whereas fear of screening would be associated with less frequent screening. Hypotheses were tested in a sample of 533 men (ages 45-70 years) recruited using a stratified cluster-sampling plan. Men provided information on demographic and structural variables (age, education, income, marital status, physician discussion of risk and screening, access, and insurance) and completed a set of anxiety measures (trait anxiety, cancer worry, and screening fear). As expected, two-step multiple regressions controlling for demographics, health insurance status, physician discussion, and health-care system barriers showed that prostate-specific antigen and digital rectal examination frequencies had unique associations with cancer worry and screening fear. Specifically, whereas cancer worry was associated with more frequent screening, fear of screening was associated with less frequent screening at least for digital rectal examination; trait anxiety was inconsistently related to screening. Data are discussed in terms of their implications for male screening and the understanding of how anxiety motivates health behaviors. It is suggested that understanding the source of anxiety and the manner in which health behaviors such as cancer screenings may enhance or reduce felt anxiety is a likely key to understanding the associations between anxiety and behavioral outcomes. (Cancer Epidemiol Biomarkers Prev 2008;17(7):1631 -9)

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“…8 In this regard, it has been reported that in men who are eligible for AS, the risk of nonorgan-confined disease (pathological upstaging) at radical prostatectomy (RP) ranges from 5%-13.7%. [9][10][11][12] Because AA men tend to have a more aggressive disease at diagnosis compared to WA men, 13,14 it is unclear whether the same AS criteria should be applied to AA men. For example, Iremashvili et al 15 recently reported that AA patients on AS have a significantly higher risk of progression than their WA counterparts.…”

mentioning

confidence: 99%

226 Increased Incidence of Pathologically Non-Organ Confined Prostate Cancer in African-American Men Eligible for Active Surveillance

Salmasi

Kim

et al. 2013

Journal of Urology

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OBJECTIVE-To compare the clinicopathologic findings of African-American (AA) and WhiteAmerican (WA) men with prostate cancer (PCa) who were candidates for active surveillance (AS) and underwent radical prostatectomy (RP).METHODS-Prospectively maintained database of men who underwent RP from 2 academic centers were analyzed retrospectively. Postoperative pathologic characteristics of patients who met the AS inclusion criteria of the University of California, San Francisco (UCSF) and National Comprehensive Cancer Network (NCCN) were evaluated. After RP, the rate of pathological upstaging and Gleason upgrading were compared between AA and WA men.RESULTS-In the AA cohort, 196 and 124 men met the UCSF and NCCN criteria for AS, respectively. With respect to WA patients, 191 and 148 fulfilled the AS criteria for UCSF and NCCN, respectively. AA men had a higher percentage of maximum biopsy core than WA men (15.3%-20.4% vs 11.5%-15.0%, P <.05, respectively) in both cohorts. In addition, a greater proportion of AA men had multiple positive biopsy cores compared to WA men (45.2% vs 33.1%, P = .046) under the NCCN criteria. A higher proportion of AA men were upstaged (≥pT3) compared to WA men (19.4% vs 10.1%, P = .037). A multivariate regression test revealed that age, preoperative PSA, and number of positive cores were independent predictors of more advanced disease (upstaging and/or upgrading) in AA men.CONCLUSION-AA men who were candidates for AS criteria had worse clinicopathological features on final surgical pathology thanWA men. These results suggest that a more stringent AS criteria should be considered in AA men with prostate cancer.African-American (AA) men have a relatively higher risk of developing prostate cancer (PCa) and dying of PCa compared to White-American (WA) men. 1-4 Between 2004 and2008, in the United States, the annual PCa incidence and mortality rates for AA men were 230.8 and 54.9 (per 100,000), respectively; whereas the respective rates for WA men were 142.8 and 22.4 (per 100, 000), respectively. 5 Although the precise reason for this racial disparity is uncertain, higher tumor grade at initial diagnosis, more aggressive tumor behavior, and poorer access to care in AA men have been suggested to contribute to these differences. 1,3,6,7 Active surveillance (AS) is an acceptable treatment option for men with low risk PCa. However, there is reluctance among health care providers and patients in accepting AS as a viable treatment option for PCa because of the inaccuracy of clinical staging. 8 In this regard, it has been reported that in men who are eligible for AS, the risk of nonorgan-confined disease (pathological upstaging) at radical prostatectomy (RP) ranges from 5%-13.7%. [9][10][11][12] Because AA men tend to have a more aggressive disease at diagnosis compared to WA men, 13,14 it is unclear whether the same AS criteria should be applied to AA men. For example, Iremashvili et al 15 recently reported that AA patients on AS have a significantly higher risk of progression than their WA coun...

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Black-white differences in the stage at presentation of prostate cancer in the district of columbia

Cited by 67 publications

References 11 publications

Explaining the Race Difference in Prostate Cancer Stage at Diagnosis

Explaining the Race Difference in Prostate Cancer Stage at Diagnosis

An Object Lesson: Source Determines the Relations That Trait Anxiety, Prostate Cancer Worry, and Screening Fear Hold with Prostate Screening Frequency

226 Increased Incidence of Pathologically Non-Organ Confined Prostate Cancer in African-American Men Eligible for Active Surveillance

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