Racial/ethnic variation in PSA testing and prostate cancer incidence following the 2012 U.S.P.S.T.F. recommendation
Menée à partir des données 2004-2017 des registres américains des cancers et à partir des données 2012-2018 du "Behavioral Risk Factor Surveillance System", cette étude analyse, en fonction de l'appartenance ethnique et de l'âge, l'évolution du taux de patients ayant bénéficié d'un dépistage du cancer de la prostate par dosage du PSA après les recommandations en 2012 de l'"United States Preventive Services Task Force"
Background : The 2012 US Preventive Services Task Force (USPSTF) recommendation against routine prostate-specific antigen (PSA) testing led to a decrease in prostate cancer screening, but the heterogeneity of its impact by race/ethnicity remains unclear.
Methods : The proportion of 40–74 year-old men who self-reported receiving a routine PSA test in the past year was estimated in the Behavioral Risk Factor Surveillance System (BRFSS; 2012–2018). Odds ratios (ORs) of undergoing screening by race/ethnicity were estimated, adjusting for healthcare-related factors. Prostate cancer incidence rates and rate ratios (IRRs) by race/ethnicity were estimated using Surveillance, Epidemiology and End Results registry data (2004–2017).
Results : PSA testing frequencies were 32.3% (95% CI = 31.7 to 32.8%) among non-Hispanic White (NHW), 30.3% (95% CI = 28.3 to 32.3%) among non-Hispanic Black (NHB), 21.8% (95% CI = 19.9 to 23.7%) among Hispanic, and 17.7% (95% CI = 14.1 to 21.3%) among Asian/Pacific Islander men in 2012. The absolute screening frequency declined by 9.5% from 2012 to 2018, with a larger decline among NHB (11.6%) than NHW men (9.3%). The relative annual decrease was greater among NHB (OR = 0.86, 95% CI = 0.84 to 0.88) than NHW men (OR = 0.89, 95% CI = 0.89 to 0.90; Pheterogeneity =0.005), driven by a larger decline among NHB men ages 40–54 y. The NHB: NHW IRR for total prostate cancer increased from 1.73 (95% CI = 1.69 to 1.76) in 2011 to 1.87 (95% CI = 1.83 to 1.92) in 2012 and has remained elevated, driven by differences in localized tumor incidence. Metastatic disease incidence is rising across all racial/ethnic groups.
Conclusions : The frequency of prostate cancer screening varies by race/ethnicity, and there was a modestly steeper decline in PSA testing among younger NHB men relative to NHW men since 2012. The NHB: NHW IRR for localized prostate cancer modestly increased following 2012.
Journal of the National Cancer Institute , résumé, 2019