Prostate-Specific Antigen Testing in Black and White Men: An Analysis of Medicare Claims From 1991-1998

Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA.
Urology (Impact Factor: 2.19). 03/2002; 59(2):251-5. DOI: 10.1016/S0090-4295(01)01516-3
Source: PubMed


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.
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 excluded.
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.
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.

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    • "This suggests that in addition to the ethnographic genetic factor, a nongenetic factor or rather a strong interaction between genetic and environmental factors may be involved in countries or territories with high rates of prostate cancer incidence. However, values of prostate cancer incidence in Caribbean countries or territories where there is no available specific cancer incidence registry may be underestimated, because uptake of PSA testing might be lower, as it may be the case in USA for black men in comparison to with Caucasians [36]. As discussed above, a difference in PSA screening use between Martinique and metropolitan France is unlikely. "
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    ABSTRACT: Prostate cancer incidence is steadily increasing in many developed countries. Because insular populations present unique ethnic, geographical, and environmental characteristics, we analyzed the evolution of prostate cancer age-adjusted world standardized incidence rates in Martinique in comparison with that of metropolitan France. We also compared prostate cancer incidence rates, and lifestyle-related and socioeconomic markers such as life expectancy, dietary energy, and fat supply and consumption, with those in other Caribbean islands, France, UK, Sweden, and USA. The incidence rate of prostate cancer in Martinique is one of the highest reported worldwide; it is continuously growing since 1985 in an exponential mode, and despite a similar screening detection process and lifestyle-related behaviour, it is constantly at a higher level than in metropolitan France. However, Caribbean populations that are genetically close to that of Martinique have generally much lower incidence of prostate cancer. We found no correlation between prostate cancer incidence rates, life expectancy, and diet westernization. Since the Caribbean African descent-associated genetic susceptibility factor would have remained constant during the 1980-2005, we suggest that in Martinique some environmental change including the intensive use of carcinogenic organochlorine pesticides might have occurred as key determinant of the persisting highly growing incidence of prostate cancer.
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    • "Data from the United States, Africa, and the Caribbean demonstrate that significant ethnic variations for prostate cancer risk exist [4] [5] [6] [7]. The incidence rate for American black men is estimated to be around 55% greater than that for American white men [4], although this value is likely to be an underestimate because uptake of prostate-specific antigen (PSA) testing is lower in black men [8]. Incidence rates from the Caribbean and Africa are more variable and, in general, much lower than those of black men in the United States, but it is hard to know whether this information reflects a genuine lower risk or a less complete case ascertainment due to limited provision of urologic services and less thorough health information systems. "
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    ABSTRACT: It is known that African American men have a greater risk of prostate cancer than white men. We investigated whether this was true for first-generation black Caribbean and black African men in the United Kingdom. A clinical cohort study design recruiting all cases of prostate cancer diagnosed over a 5-yr period and residing in defined areas of London and Bristol. We calculated the age-standardised incidence rates and relative risk for all black men, and black Caribbean and black African men versus white men. Black men had higher age-adjusted rates of prostate cancer (166 per 100,000, 95% confidence interval [95%CI], 151-180 per 100,000) than white men (56.4 per 100,000, 95%CI, 53.3-59.5 per 100,000). The relative risks for all black, black Caribbean, and black African men were 3.09 (95%CI, 2.79-3.43; p<0.0001), 3.19 (95%CI, 2.85-3.56; p<0.0001) and 2.87 (95%CI, 2.34-3.53; p<0.0001), respectively. There was no strong evidence that the rates for black Caribbean differed from black African men. The higher risk in black men compared with white men was more apparent in younger age groups (p value for interaction<0.001). Black men in the United Kingdom have substantially greater risk of developing prostate cancer compared with white men, although this risk is lower than that of black men in the United States. The similar rates in black Caribbean and black African men suggest a common genetic aetiology, although migration may be associated with an increased risk attributable to a gene-environment interaction.
    Full-text · Article · Feb 2008 · European Urology
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    • "Hence, cases and controls may not be appropriately ''representative'' as might be the case in screening for prostate cancer. It is known that African-Americans have a high-risk for prostate cancer, but the frequency of PSA testing in this population is low compared with the Whites [9]. "
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    ABSTRACT: ObjectivesOngoing randomized controlled screening trials for prostate cancer have not shown a beneficial effect on prostate cancer mortality reduction yet. A large number of observational (non-randomized) studies on prostate cancer screening have been published with contradictory outcome. This paper reviews the current case-control studies.MethodsSeven case-control studies of screening for prostate cancer were identified in a PubMed search, published from 1991 onwards, all conducted in North America. The screening test was either digital rectal examination (DRE) alone or in combination with PSA.ResultsOne DRE case-control study, found a significant preventive effect, whereas two others showed no effect of DRE screening on prostate cancer mortality nor on the occurrence of metastatic disease. Conflicting results were also observed in the studies assessing the effect of PSA/DRE. Only one study showed a significant 27% mortality reduction in the White male cohort, but found no effects in Blacks. The most recent study showed that screening with PSA/DRE was not protective in reducing prostate cancer mortality.ConclusionsOur review of the case-control studies does not indicate a benefit of prostate cancer screening. An answer has to come from the ERSPC trial, in Europe, and the PLCO trial, in the US, of which the outcomes are expected in 2007–2010.
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