PROSTATE-SPECIFIC ANTIGEN TESTING IN BLACK AND?
WHITE MEN: AN ANALYSIS OF MEDICARE CLAIMS?
RUTH ETZIONI, KRISTIN M. BERRY, JULIE M. LEGLER, AND PAMELA SHAW
Objectives. To describe the trends in prostate-specific antigen (PSA) use and associated cancer detection
among black and white Medicare beneficiaries older than 65 years during the calendar period from January
1991 through December 1998.
Methods. Medicare claims data were linked with cancer registry data from the Surveillance, Epidemiology
and End Results program of the National Cancer Institute. Data from a 5% random sample of men without
a diagnosis of prostate cancer were combined with data from prostate cancer cases diagnosed during the
calendar period from 1991 to 1998. PSA tests conducted after a diagnosis of prostate cancer were
Results. PSA use has stabilized among white men, reaching an annual rate of 38% by 1995 and remaining
at this level through 1998. The annual rate of use among black men reached 31% by 1998, but was still
increasing at that time. By 1996, at least 80% of tests in both blacks and whites were second or later tests.
By the end of 1996, 35% of white men and 25% of black men were undergoing testing at least biannually
or more frequently. In 1996, 83% of diagnoses in whites and 77% in blacks were preceded by a PSA test.
Conclusions. Older black men lag slightly behind older white men in their use of the PSA test; however,
annual testing rates in blacks have yet to stabilize. In both race groups, an overwhelming majority of
diagnoses are associated with a PSA test, whether for screening or diagnostic purposes. Regular screening
rates in blacks are substantially lower than in whites, but the regular screening rates are relatively low in both
race groups. Should PSA screening prove efficacious, efforts to promote regular use among both black and
white men will likely be needed. UROLOGY 59: 251–255, 2002. © 2002, Elsevier Science Inc.
R. Etzioni’s research is supported in part by grants U01 CA88160
and R29 CA70227.
R. Etzioni is an Associate Member of the Public Health Sciences
Division of the Fred Hutchinson Cancer Research Center.
From the Fred Hutchinson Cancer Research Center, Seattle,
Washington; and Applied Research Branch, Cancer Surveillance
Research Program, Division of Cancer Control and Population
Sciences, National Cancer Institute, Bethesda, Maryland
Reprint requests: Ruth Etzioni, Ph.D., Fred Hutchinson Cancer
Research Center, 1100 Fairview Avenue North, MP-665, P.O.
Box 19024, Seattle, WA 98109-1024
Submitted: June 7, 2001, accepted (with revisions): September
© 2002, ELSEVIER SCIENCE INC.
ALL RIGHTS RESERVED
originally approved for monitoring disease pro
gression after the diagnosis of prostate cancer, the
test was quickly adopted for screening purposes.
By the end of 1994, approximately 53% of whites
and 45% of blacks aged 65 and older in 1988 had
had a test.1
ince its introduction, PSA testing has rapidly
disseminated in the U.S. population.1 Although
Racial disparities in the incidence of, and mortal
ity from, prostate cancer, are well-known.2,3 Black
men are more likely to be diagnosed with the dis
ease and to die of it. A number of surveys have
indicated that black men are also less likely to un
dergo PSA screening.4,5 Barriers to screening
among black men have been explored.6,7
The limitations of survey data concerning pros
tate cancer screening histories have recently been
investigated.8 The study showed that patients’ self-
reports of PSA use were discordant with their med
ical record 29% of the time, with patients tending
to over-report recent use of the test. The primary
reasons advanced for these findings were recall
bias due to memory “telescoping” and lack of
This study compared the use of PSA testing in
blacks and whites using a population-based, ad
ministrative database, which consists of a linkage
between the Surveillance, Epidemiology and End
PII S0090-4295(01)01516-3 251