Prostate Cancer Screening Guidelines for African American Veterans: A New Perspective

Reddy, Amit; Roberts, Russell; Shenoy, Divya; Packianathan, Satyaseelan; Giri, Shankar; Vijayakumar, Srinivasan

doi:10.1016/j.jnma.2018.10.010

Cited by 5 publications

(7 citation statements)

References 19 publications

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“…Given that in the general US population AA men aged <65 years are reported to demonstrate delays in diagnosis compared with NHW men, a disparity that seems to disappear after the age of Medicare eligibility, and that there is no observable difference in PC outcomes between NHW and AA men aged <65 years who have Medicaid coverage, it is plausible that equal‐access health care coverage plays an important role in outcomes for these patients. To our knowledge, it is unclear whether the improved PCSM among AA men noted in the current study cohort is due to access to care (ie, testing and other active interventions to minimize disparities) or more aggressive PC screening, treatment, and follow‐up, or if other unmeasured self‐care factors are driving this phenomenon. In addition, veterans often benefit from social support programs from the VA itself, as well as other governmental and nonprofit organizations, which also may have contributed to the findings observed herein.…”

Section: Discussionmentioning

confidence: 91%

Survival of African American and non‐Hispanic white men with prostate cancer in an equal‐access health care system

Riviere

Luterstein

Kumar

et al. 2020

Cancer

112

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Background African American (AA) men in the general US population are more than twice as likely to die of prostate cancer (PC) compared with non‐Hispanic white (NHW) men. The authors hypothesized that receiving care through the Veterans Affairs (VA) health system, an equal‐access medical system, would attenuate this disparity. Methods A longitudinal, centralized database of >20 million veterans was used to assemble a cohort of 60,035 men (18,201 AA men [30.3%] and 41,834 NHW men [69.7%]) who were diagnosed with PC between 2000 and 2015. Results AA men were more likely to live in regions with a lower median income ($40,871 for AA men vs $48,125 for NHW men; P < .001) and lower high school graduation rates (83% for AA men vs 88% for NHW men; P < .001). At the time of diagnosis, AA men were younger (median age, 63.0 years vs 66.0 years; P < .001) and had a higher prostate‐specific antigen level (median, 6.7 ng/mL vs 6.2 ng/mL; P < .001), but were less likely to have Gleason score 8 to 10 disease (18.8% among AA men vs 19.7% among NHW men; P < .001), a clinical T classification ≥3 (2.2% vs 2.9%; P < .001), or distant metastatic disease (2.7% vs 3.1%; P = 0.01). The 10‐year PC‐specific mortality rate was slightly lower for AA men (4.4% vs 5.1%; P = .005), which was confirmed in multivariable competing‐risk analysis (subdistribution hazard ratio, 0.85; 95% CI, 0.78‐0.93; P < .001). Conclusions AA men diagnosed with PC in the VA health system do not appear to present with more advanced disease or experience worse outcomes compared with NHW men, in contrast to national trends, suggesting that access to care is an important determinant of racial equity.

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Section: Discussionmentioning

confidence: 91%

Survival of African American and non‐Hispanic white men with prostate cancer in an equal‐access health care system

Riviere

Luterstein

Kumar

et al. 2020

Cancer

112

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“…Some differences may be explained by systemic biases in our delivery of health care. It was previously established that there are disparities in incidence and mortality in African American men compared with White men but that social determinants of care may be associated with some observed differences . Further compounding the social determinants of care are findings that under a shared decision-making model, African American and White men note differences in the value of screening .…”

Section: Discussionmentioning

confidence: 99%

“…It was previously established that there are disparities in incidence and mortality in African American men compared with White men 26 but that social determinants of care may be associated with some observed differences. 27 Further compounding the social determinants of care are findings that under a shared decision-making model, African American and White men note differences in the value of screening. 28 Taken together, these data suggest that guidelines need to not only reflect evidence-based medicine, but also consider how complex the operationalization of the recommendations may be and support the need for diverse advocacy in the recommendation process.…”

Section: Discussionmentioning

confidence: 99%

Variations in Age-Adjusted Prostate Cancer Incidence Rates by Race and Ethnicity After Changes in Prostate-Specific Antigen Screening Recommendation

et al. 2022

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ImportanceAfter publication of US Preventive Task Force Prostate-Specific Antigen (PSA) screening guidelines in 2008 and 2012, there have been documented associations with incidence and stage distributions of prostate cancer. It is unclear if these changes were temporary or differed by age or race and ethnicity.ObjectiveTo assess the association of 2008 and 2012 PSA guidelines with prostate cancer incidence by age and race and ethnicity in the US.Design, Setting, and ParticipantsThis cross-sectional study evaluated prostate cancer incidence from 2005 to 2018 in the US using data from the US Cancer Statistics public use database. Data were analyzed from August 2020 through June 2022.Main Outcomes and MeasuresThe primary outcome was the year when rates of prostate cancer incidence changed directionality by age and race and ethnicity. Age-adjusted incidence rates of prostate cancer and corresponding 95% CIs were created, followed by join point regression analysis to evaluate trends of age-adjusted incidence rates of prostate cancer by age, race, Hispanic ethnicity, and stage of diagnosis.ResultsAmong 2 944 387 men with prostate cancer, 2 869 943 (97.5%) men were aged 50 years and older. Men aged 50 years and older accounted for 185 476 of 191 533 Hispanic individuals (96.8%) and 2 684 467 of 2 752 854 non-Hispanic individuals (97.5%). Men aged 50 years and older accounted for 427 016 of 447 847 African American individuals (95.4%), 12 141 of 12 470 American Indian or Alaska Native individuals (97.4%), 61 126 of 62 159 Asian or Pacific Islander individuals (98.3%), and 2 294 171 of 2 344 392 White individuals (97.9%). Men with unknown race (77 519 men) were excluded from the analysis. A decrease in age-adjusted rate of prostate cancer after the 2008 guideline change was observed in all age groups by race and ethnicity. For example, among African American men ages 65 to 74 years, 10 784 of 807 080 men (1.34%) had a prostate cancer diagnosis in 2007 vs 10 714 of 835 548 men in 2008 (1.28%). The mean annual age-adjusted incidence rates of prostate cancer per 100 000 men were 157.7 men (95% CI, 157.4-158.0 men) in 2005 to 2008 and 131.9 men (95% CI, 131.6-132.2 men) in 2009 to 2012. The number of inflections and annual percent changes (APCs) for segments separated by inflections varied by age, race, and Hispanic ethnicity. For men ages 65 to 74 years, the APC was −6.53 (95% CI, −9.28 to −3.69) for 2009 to 2014 among African American men (2 join points), −5.96 (95% CI, −6.84 to −5.07) for 2007 to 2018 among American Indian or Alaska Native men (1 join point), −6.52 (95% CI, −9.22 to −3.74) for 2007 to 2014 among Asian or Pacific Islander men (2 join points), −7.92 (95% CI, −11.36 to −4.35) for 2009 to 2014 among Hispanic men (2 join points), and −7.02 (95% CI, −9.41 to −4.57) for 2007 to 2014 among White men (2 join points).‬‬‬‬‬‬‬‬Conclusions and RelevanceIn this study, men in different age, race, and ethnicity groups had different APC patterns after 2008 and 2012 PSA screening guideline changes. These findings may provide important data on the timing and durations of changes in cancer diagnoses that are associated with changes in PSA screening recommendations and may be valuable for targeted strategies to reduce regional- and distant-staged cancers.

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“…10,19,20 Because of this increased risk, it can be argued that Black men should be screened at an earlier age and/or more frequently than White men. 9,10 Further investigation is warranted to confirm and better understand why referral patterns are different for Black men.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Prostate Specific Antigen Screening and Referral to Urology in a Large, Integrated Health Care System: A Retrospective Cohort Study

Adeyemi²,

Anderson³

et al. 2021

Journal of Urology

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Purpose: Contemporary trends and racial disparities in prostate cancer screening and referral to urology for prostate cancer risk are not well characterized, despite consensus that Black men are at higher risk for poor prostate cancer outcomes. The objective of this study was to characterize current racial disparities in prostate cancer screening and referral from primary care to urology for prostate cancer concern within our large, integrated health care system. Materials and Methods: This retrospective cohort study used data from Atrium Health's enterprise data warehouse, which includes patient information from more than 900 care locations across North Carolina, South Carolina and Georgia. We included all men seen in the ambulatory or outpatient setting between 2014 and 2019 who were 40 years old. Clinical and demographic data were collected for all men, including age and race. Racial outcomes were reported for all groups with >2% representation in the population. Between-group comparisons were determined using chi-squared analysis, Wilcoxon rank sum testing and multivariable logistic regression, with significance defined as p <0.05. Results: We observed a significant decrease in prostate specific antigen testing across all age and racial groups in a cohort of 606,985 men at Atrium Health, including 87,189 Black men, with an overall relative decline of 56%. As compared to White men, Black men were more likely to undergo prostate specific antigen testing (adjusted OR 1.24, 95% CI 1.22e1.26) and be referred to urology for prostate cancer (adjusted OR 1.94, 95% CI 1.75e2.16). Conclusions: There was a continued significant decline in prostate cancer screening between 2014 and 2019. Despite having modestly elevated odds of being screened for prostate cancer compared to White men, Black men are relatively underscreened when considering that those who undergo prostate specific antigen screening are more likely to be referred by primary care to urology for additional prostate cancer diagnostic evaluation.

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Prostate Cancer Screening Guidelines for African American Veterans: A New Perspective

Cited by 5 publications

References 19 publications

Survival of African American and non‐Hispanic white men with prostate cancer in an equal‐access health care system

Survival of African American and non‐Hispanic white men with prostate cancer in an equal‐access health care system

Variations in Age-Adjusted Prostate Cancer Incidence Rates by Race and Ethnicity After Changes in Prostate-Specific Antigen Screening Recommendation

Racial Disparities in Prostate Specific Antigen Screening and Referral to Urology in a Large, Integrated Health Care System: A Retrospective Cohort Study

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