1
|
Disparities in germline testing among racial minorities with prostate cancer. Prostate Cancer Prostatic Dis 2021; 25:403-410. [PMID: 34775478 PMCID: PMC8590439 DOI: 10.1038/s41391-021-00469-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022]
Abstract
Germline testing is becoming increasingly relevant in prostate cancer (PCa) screening, prognosis, and management. A subset of patients with PCa harbor pathogenic/likely pathogenic variants (P/LPVs) in genes mediating DNA-repair processes, and these P/LPVs have implications for cancer screening, treatment, and cascade testing. As a result, it is recommended that all men with high-risk localized and metastatic PCa undergo routine germline testing. As more PCa patients undergo germline testing, it is important that clinicians and genetics experts recognize current disparities in germline testing rates among racial/ethnic minorities in the United States. The reasons for these disparities are multiple and require similarly manifold consideration to close the germline testing gap and reduce inequities in PCa screening, management, and treatment.
Collapse
|
2
|
Georgantopoulos P, Eberth JM, Cai B, Rao G, Bennett CL, Emrich CT, Haddock KS, Hébert JR. A spatial assessment of prostate cancer mortality-to-incidence ratios among South Carolina veterans: 1999-2015. Ann Epidemiol 2021; 59:24-32. [PMID: 33836289 DOI: 10.1016/j.annepidem.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess veteran-specific prostate cancer (PrCA) mortality-to-incidence ratios (MIR) in South Carolina's (SC) veteran population. METHODS U.S. Veterans Health Administration electronic medical records from January 1999 to December 2015 identified 3,073 PrCA patients residing in 345 ZIP code tabulation areas (ZCTA) within SC. MIRs were calculated for all SC ZCTAs and by key patient- and neighborhood-level risk factors for PrCA. Comparisons between ZCTAs identified as part of a spatial cluster were compared with non-significant ZCTAs using t tests. RESULTS The MIR was 0.17 overall, ranging from a low of 0.15 among Black men to 0.20 among White men. Among metropolitan ZCTAs, the MIR was 0.18 compared to 0.16 in non-metropolitan ZCTAs. Two clusters of higher-than-expected MIRs were found in the Upstate region. CONCLUSIONS Identification of spatial clusters of higher- or lower-than-expected MIRs allows for further testing of possible explanatory factors, and the capacity to target resources and policies according to greatest need.
Collapse
Affiliation(s)
- Peter Georgantopoulos
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC; Southern Network on Adverse Reactions (SONAR), South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, SC; Columbia Veterans Affairs Health Care System, Columbia, SC.
| | - Jan M Eberth
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Gowtham Rao
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Charles L Bennett
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC; Southern Network on Adverse Reactions (SONAR), South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, SC; Columbia Veterans Affairs Health Care System, Columbia, SC
| | - Christopher T Emrich
- College of Community Innovation and Education, University of Central Florida, Orlando, FL
| | | | - James R Hébert
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| |
Collapse
|
3
|
Adekoya TO, Smith N, Thomas AJ, Lane TS, Burnette N, Rivers EJ, Li Y, Chen XL, Richardson RM. Host versus cell-dependent effects of β-arrestin 1 expression in prostate tumorigenesis. Carcinogenesis 2021; 42:772-783. [PMID: 33710266 DOI: 10.1093/carcin/bgab021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/24/2021] [Accepted: 03/10/2021] [Indexed: 11/14/2022] Open
Abstract
Prostate cancer (PCa) constitutes a serious health challenge and remains one of the main causes of cancer-related death among men. The more aggressive form of the disease has been attributed to androgen independence, resulting in a lack of response to androgen deprivation therapy and sustained activation of other growth pathways. The scaffold proteins β-arrestin 1 and 2 (βarr1 and βarr2), which are known to mediate G protein-coupled receptor desensitization and internalization, were also shown to modulate prostate tumorigenesis. βarr1 is significantly overexpressed (>4-fold) in PCa cells relative to βarr2. In this study, we investigated the effect of βarr1 overexpression in PCa development and progression using the mouse and human PCa cell xenografts, and autochthonous transgenic adenocarcinoma of the mouse prostate (TRAMP) models deficient in β-arrestin depletion of βarr1 in TRAMP mice (TRAMP/βarr1-/-) increased PCa growth and decreased overall survival relative to control TRAMP or TRAMP/βarr2-/- animals. Prostate tissues from TRAMP/βarr1-/- tumors displayed an increase in androgen receptor (AR) expression, whereas overexpression of βarr1 in TRAMP-C1 (TRAMP-C1-βarr1-GFP) which derived from TRAMP decreased AR expression, cell proliferation and tumor growth in nude mice xenografts, relative to control TRAMP-C1-GFP. Knockdown of βarr1 expression in human MDA PCa 2b cells (MDA PCa 2b-βarr1-/-) also decreased AR expression cell proliferation and tumor growth relative to control (MDA PCa 2b-Sham) cells. Interestingly, both TRAMP-C1-βarr1-GFP and MDA PCa 2b-βarr1-/- xenografts showed a decrease in AKT phosphorylation but an increase in MAPK activation. Altogether, the data indicate that the effect of βarr1 in modulating AR signaling to regulate PCa aggressiveness is cell and host autonomous.
Collapse
Affiliation(s)
- Timothy O Adekoya
- Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, NC 27707, USA
| | - Nikia Smith
- Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, NC 27707, USA
| | - Ariel J Thomas
- Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, NC 27707, USA
| | - Tonya S Lane
- Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, NC 27707, USA
| | - Nija Burnette
- Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, NC 27707, USA
| | - Elizabeth J Rivers
- Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, NC 27707, USA
| | - Yahui Li
- Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, NC 27707, USA
| | - Xiaoxin L Chen
- Department of Biological & Biomedical Sciences, North Carolina Central University, Durham, NC 27707, USA
| | - Ricardo M Richardson
- Department of Biological & Biomedical Sciences, North Carolina Central University, Durham, NC 27707, USA
| |
Collapse
|
4
|
Montiel Ishino FA, Rowan C, Das R, Thapa J, Cobran E, Whiteside M, Williams F. Identifying Risk Profiles of Malignant Prostate Cancer Surgical Delay Using a Person-Centered Approach to Understand Prostate Cancer Disparities: The Constellation of Health Determinants Using Latent Class Analysis on Cancer Registry Data. Am J Mens Health 2020; 14:1557988320984282. [PMID: 33372564 PMCID: PMC7783683 DOI: 10.1177/1557988320984282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Surgical prostate cancer (PCa) treatment delay (TD) may increase the likelihood
of recurrence of disease, and influence quality of life as well as survival
disparities between Black and White men. We used latent class analysis (LCA) to
identify risk profiles in localized, malignant PCa surgical treatment delays
while assessing co-occurring social determinants of health. Profiles were
identified by age, marital status, race, county of residence (non-Appalachian or
Appalachian), and health insurance type (none/self-pay, public, or private)
reported in the Tennessee Department of Health cancer registry from 2005 to 2015
for adults ≥18 years (N = 18,088). We identified three risk
profiles. The highest surgical delay profile (11% of the sample) with a 30%
likelihood of delaying surgery >90 days were young Black men, <55 years
old, living in a non-Appalachian county, and single/never married, with a high
probability of having private health insurance. The medium surgical delay
profile (46% of the sample) with a 21% likelihood of delay were 55–69 years old,
White, married, and having private health insurance. The lowest surgical delay
profile (42% of the sample) with a 14% likelihood of delay were ≥70 years with
public health insurance as well as had a high probability of being White and
married. We identified that even with health insurance coverage, Blacks living
in non-Appalachian counties had the highest surgical delay, which was almost
double that of Whites in the lowest delay profile. These disparities in PCa
surgical delay may explain differences in health outcomes in Blacks who are most
at-risk.
Collapse
Affiliation(s)
- Francisco A Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Claire Rowan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rina Das
- Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Janani Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Ewan Cobran
- Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Martin Whiteside
- Tennessee Cancer Registry, Tennessee Department of Health, Nashville, TN, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
5
|
Georgantopoulos P, Eberth JM, Cai B, Emrich C, Rao G, Bennett CL, Haddock KS, Hébert JR. Patient- and area-level predictors of prostate cancer among South Carolina veterans: a spatial analysis. Cancer Causes Control 2020; 31:209-220. [DOI: 10.1007/s10552-019-01263-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/21/2019] [Indexed: 12/29/2022]
|
6
|
Muralidhar V, Nguyen PL, Mahal BA, Yang DD, Mouw KW, Rose BS, Beard CJ, Efstathiou JA, Martin NE, King MT, Orio PF. Practice Patterns and Outcomes Among Patients With N0M0 Prostate Cancer and a Very High Prostate-Specific Antigen Level. J Natl Compr Canc Netw 2019; 17:941-948. [DOI: 10.6004/jnccn.2018.7283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/08/2019] [Indexed: 11/17/2022]
Abstract
Background: Management of patients with a very high prostate-specific antigen (PSA) level (≥98.0 ng/mL) but clinically localized (N0M0) prostate cancer is challenging. This study sought to determine practice patterns and outcomes among these patients. Patients and Methods: A total of 748,825 patients with prostate cancer from 2004 through 2012 were identified using the National Cancer Database. These patients were subdivided by PSA level (0–9.9, 10.0–19.9, 20.0–39.9, 40.0–59.9, 60.0–79.9, 80.0–97.9, and ≥98.0 ng/mL), nodal status (N0 vs N1), and distant metastases (M0 vs M1). Rates of locoregional treatment and 5-year overall survival (OS) in each group were determined. Survival was compared using Cox regression after adjusting for multiple patient-specific factors. Results: The rate of locoregional treatment for patients with N0M0 disease and PSA level ≥98.0 ng/mL was significantly lower than for those with N1M0 disease (52.6% vs 60.4%; P<.001) or N0M0 disease and PSA level <98.0 ng/mL (52.6% vs 86.6%; P<.001). The 5-year OS rate was similar for patients with N1M0 disease and those with N0M0 disease and a very high PSA level (63.2% vs 59.1%; adjusted hazard ratio [aHR], 0.91; P=.063). The survival benefit associated with locoregional treatment was higher among those with N0M0 disease and a very high PSA level than among those with N1M0 disease (aHR, 0.28 vs 0.44; P<.001). Conclusions: Patients with clinical N0M0 disease and a very high PSA level (≥98.0 ng/mL) have outcomes similar to those with N1 disease but receive locoregional treatment at a lower rate. Future work is needed to investigate the utility of locoregional treatment in this population.
Collapse
Affiliation(s)
| | - Paul L. Nguyen
- bDepartment of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Brandon A. Mahal
- aHarvard Radiation Oncology Program, Harvard Medical School, and
| | - David D. Yang
- aHarvard Radiation Oncology Program, Harvard Medical School, and
| | - Kent W. Mouw
- bDepartment of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Brent S. Rose
- cDepartment of Radiation Oncology, University of California at San Diego, La Jolla, California; and
| | - Clair J. Beard
- bDepartment of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jason A. Efstathiou
- dDepartment of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Neil E. Martin
- bDepartment of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Martin T. King
- bDepartment of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Peter F. Orio
- bDepartment of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| |
Collapse
|
7
|
Link between prostate cancer diagnosis and stroke in the United States during 2007-2017. ACTA ACUST UNITED AC 2019; 4:e94-e102. [PMID: 31211276 PMCID: PMC6554749 DOI: 10.5114/amsad.2019.85383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/24/2019] [Indexed: 12/24/2022]
Abstract
Introduction The main purpose of this work is to study prostate cancer and stroke in the United States during the years 2007-2017 and to find not only statistically significant predictors for cancer, but also a possible association between prostate cancer and stroke. Material and methods The statistical methods used to derive the results of this work are χ2 test and one-way analysis of variance (ANOVA), in order to check the statistical significance of prostate cancer in relation to socio-economic factors of patients. In addition, a multivariate logistic regression analysis was used with the odds ratio (OR) to find statistically significant prognostic factors for both prostate cancer and stroke. Results According to multiple logistic regression analysis, males who are unemployed but have worked previously have 16 times higher risk of developing prostate cancer, while widowed men have five times higher risk for the occurrence of this type of cancer. In addition, marital status and employment proved to be also prognostic risk factors for stroke. Conclusions Our results describe for the first time the importance of deprivation (of work and partner) as a primary prognostic risk factor for cancer. Moreover, the same factor proved to be the primary prognostic risk factor for stroke as well as for prostate cancer, a fact that implies a possible link between cancer and stroke.
Collapse
|
8
|
Yedjou CG, Mbemi AT, Noubissi F, Tchounwou SS, Tsabang N, Payton M, Miele L, Tchounwou PB. Prostate Cancer Disparity, Chemoprevention, and Treatment by Specific Medicinal Plants. Nutrients 2019; 11:E336. [PMID: 30720759 PMCID: PMC6412894 DOI: 10.3390/nu11020336] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/02/2019] [Accepted: 01/29/2019] [Indexed: 12/16/2022] Open
Abstract
Prostate cancer (PC) is one of the most common cancers in men. The global burden of this disease is rising. Its incidence and mortality rates are higher in African American (AA) men compared to white men and other ethnic groups. The treatment decisions for PC are based exclusively on histological architecture, prostate-specific antigen (PSA) levels, and local disease state. Despite advances in screening for and early detection of PC, a large percentage of men continue to be diagnosed with metastatic disease including about 20% of men affected with a high mortality rate within the African American population. As such, this population group may benefit from edible natural products that are safe with a low cost. Hence, the central goal of this article is to highlight PC disparity associated with nutritional factors and highlight chemo-preventive agents from medicinal plants that are more likely to reduce PC. To reach this central goal, we searched the PubMed Central database and the Google Scholar website for relevant papers. Our search results revealed that there are significant improvements in PC statistics among white men and other ethnic groups. However, its mortality rate remains significantly high among AA men. In addition, there are limited studies that have addressed the benefits of medicinal plants as chemo-preventive agents for PC treatment, especially among AA men. This review paper addresses this knowledge gap by discussing PC disparity associated with nutritional factors and highlighting the biomedical significance of three medicinal plants (curcumin, garlic, and Vernonia amygdalina) that show a great potential to prevent/treat PC, as well as to reduce its incidence/prevalence and mortality, improve survival rate, and reduce PC-related health disparity.
Collapse
Affiliation(s)
- Clement G Yedjou
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Jackson, MS 39217, USA.
| | - Ariane T Mbemi
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Jackson, MS 39217, USA.
| | - Felicite Noubissi
- Department of Biology, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Jackson, MS 39217, USA.
| | - Solange S Tchounwou
- Department of Biology, University of Mississippi, 214 Shoemaker Hall, P.O. Box 1848, MS 38677, USA.
| | - Nole Tsabang
- Department of Animal Biology, Higher Institute of Environmental Sciences, Yaounde P.O.Box 16317, Cameroon.
| | - Marinelle Payton
- Center of Excellence in Minority Health and Health Disparities, School of Public Health, Jackson State University, Jackson Medical Mall-Thad Cochran Center, 350 West Woodrow Wilson Avenue, Jackson, MS 39213, USA.
| | - Lucio Miele
- Department of Genetics, LSU Health Sciences Center, School of Medicine, 533 Bolivar Street, Room 657, New Orleans, LA 70112, USA.
| | - Paul B Tchounwou
- Department of Biology, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Jackson, MS 39217, USA.
| |
Collapse
|
9
|
Cobran EK, Young HN, Chen RC, Chen X, Reeves J, Godley PA, Shah S. Race and Time to Receipt of Androgen Deprivation Therapy Among Men With Metastatic Prostate Cancer. J Natl Med Assoc 2018; 111:246-255. [PMID: 30389146 DOI: 10.1016/j.jnma.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/05/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Medicare Modernization Act (MMA) drastically reduced reimbursement for androgen deprivation therapy (ADT) in 2005. One unintended consequence of the MMA may be an increase in the racial disparities in receipt of ADT. Given these policy changes, it becomes increasingly important to assess racial disparities in timely receipt of ADT. METHODS The purpose of this study is to evaluate the associations between race and median time to receipt of ADT among men with metastatic prostate cancer before and after the passage of the MMA. A population-based retrospective cohort was created from the Surveillance, Epidemiology, and End Results-Medicare. RESULTS A total of 1,846 African-American and 9,462 Caucasian men diagnosed with metastatic prostate cancer from 2000 through 2011 were included. An accelerated failure time regression model was used to examine factors associated with racial differences in median time to receipt of ADT. Results indicate that African-American men had a longer median time to receipt of ADT both before the MMA (Time Ratio (TR): 1.15; 95% Confidence Interval (CI) [1.05, 1.27]) and after the MMA (TR: 1.29; 95% CI [1.10, 1.53]) as compared to Caucasian men. In addition to race, men residing in South had longer median time to receipt of ADT (TR: 1.26, 1.52; 95% CI [1.01, 1.52; 1.24, 1.87] before and after MMA, respectively) compared to the Northeast region. CONCLUSION Considering the palliative benefits of ADT, it is important to develop effective strategies to address racial differences in receipt of treatment for metastatic prostate cancer.
Collapse
Affiliation(s)
- Ewan K Cobran
- University of Georgia, College of Pharmacy, Department of Clinical and Administrative Pharmacy, Division of Pharmaceutical Health Services, Outcomes, and Policy, Robert C. Wilson Pharmacy 250 West Green Street, 270B, Athens, GA 30602, USA.
| | - Henry N Young
- University of Georgia, College of Pharmacy, Department of Clinical and Administrative Pharmacy, Division of Pharmaceutical Health Services, Outcomes, and Policy, Robert C. Wilson Pharmacy 250 West Green Street, 270J, Athens, GA 30602, USA
| | - Ronald C Chen
- University of North Carolina at Chapel Hill, School of Medicine, Department of Radiation Oncology and Urology, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Xianyan Chen
- University of Georgia, Franklin College of Arts and Sciences, Department of Statistics, Statistical Consulting Center, 310 Herty Drive, Athens, GA 30602, USA
| | - Jaxk Reeves
- University of Georgia, Franklin College of Arts and Sciences, Department of Statistics, Statistical Consulting Center, 310 Herty Drive, Athens, GA 30602, USA
| | - Paul A Godley
- University of North Carolina at Chapel Hill, School of Medicine, Department of Hematology and Oncology, 4064 Bondurant Hall, Chapel Hill, NC 27514, USA
| | - Surbhi Shah
- Evidera, Real-World Evidence, 500 Totten Pond Road, Waltham, MA 02451, USA
| |
Collapse
|
10
|
Brown CR, Hambleton I, Hercules SM, Unwin N, Murphy MM, Nigel Harris E, Wilks R, MacLeish M, Sullivan L, Sobers-Grannum N. Social determinants of prostate cancer in the Caribbean: a systematic review and meta-analysis. BMC Public Health 2018; 18:900. [PMID: 30029628 PMCID: PMC6053791 DOI: 10.1186/s12889-018-5696-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/11/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Prostate cancer remains the leading cause of cancer deaths among Caribbean men. However, little data exists on the influence of social factors on prostate cancer in the Caribbean setting. This article supports the 2011 Rio Political Declaration on addressing health inequalities by presenting a systematic review of evidence on the role of social determinants on prostate cancer in Caribbean men. It aims to determine the distribution, by known social determinants of health, of the frequency and adverse outcomes of prostate cancer among Caribbean populations. METHODS Observational studies reporting an association between a social determinant and prostate cancer frequency and outcomes were sought in MEDLINE, EMBASE, SciELO, CINAHL, CUMED, LILACS, and IBECS databases. Fourteen social determinants and 7 prostate cancer endpoints were chosen, providing 98 possible relationship groups exploring the role of social determinants on prostate cancer. Observational studies with > 50 participants conducted in Caribbean territories between 2004 and 2016 were eligible. The review was conducted according to STROBE and PRISMA guidelines. Random-effects meta-analyses were performed. RESULTS From 843 potentially relevant citations, 13 articles from 9 studies were included. From these included studies, 24 relationships were reported looking at 11 distinct relationship groups, leaving 90 relationship groups (92% of all relationship groups) unexplored. Study heterogeneity and risk of bias restricted results to a narrative synthesis in most instances. Meta-analyses showed more diagnosed prostate cancer among men with less formal education (n = 2 studies, OR 1.60, 95%CI 1.18-2.19) and among men who were married (n = 3 studies, OR 1.54, 95%CI 1.22-1.95). CONCLUSIONS This review highlights limited evidence for a higher occurrence of diagnosed prostate cancer among Caribbean men with lower levels of education and among men who are married. The role of social determinants on prostate cancer among Caribbean men remains poorly understood. Improvements in study quantity and quality, and reduced variability in outcomes and reporting are needed. This report represents the current evidence, and provides a roadmap to future research priorities for a better understanding of Caribbean prostate cancer inequalities.
Collapse
Affiliation(s)
- Catherine R. Brown
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Ian Hambleton
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Shawn M. Hercules
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
- Department of Biology, McMaster University, Hamilton, ON Canada
| | - Nigel Unwin
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Madhuvanti M. Murphy
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados
| | | | | | | | | | | |
Collapse
|
11
|
Muralidhar V, Mahal BA, Rose BS, Chen YW, Nezolosky MD, Efstathiou JA, Beard CJ, Martin NE, Orio PF, Trinh QD, Choueiri TK, Sweeney CJ, Nguyen PL. Disparities in the Receipt of Local Treatment of Node-positive Prostate Cancer. Clin Genitourin Cancer 2017; 15:563-569.e3. [DOI: 10.1016/j.clgc.2016.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 11/16/2022]
|
12
|
Late Diagnosis, Smoking History and Socioeconomic Inequality in Gastric Carcinoma: A Decomposition Approach. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.3754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
13
|
Kilpeläinen TP, Talala K, Raitanen J, Taari K, Kujala P, Tammela TLJ, Auvinen A. Prostate Cancer and Socioeconomic Status in the Finnish Randomized Study of Screening for Prostate Cancer. Am J Epidemiol 2016; 184:720-731. [PMID: 27777219 DOI: 10.1093/aje/kww084] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 07/18/2016] [Indexed: 01/09/2023] Open
Abstract
Prostate cancer (PC) screening remains controversial. We investigated whether screening reduces the difference in prostate cancer risk by socioeconomic status (SES). In 1996-2011, a total of 72,139 men from the Finnish Randomized Study of Screening for Prostate Cancer were analyzed. Outcome measures were PC incidence, mortality, and participation in screening. SES indicators were educational level, income, and home ownership status (data obtained from the Statistics Finland registry). The mean duration of follow-up was 12.7 years. Higher SES was associated with a higher incidence of low- to moderate-risk PC but with a lower risk of advanced PC. Higher education was associated with significantly lower PC mortality in both control and screening arms (risk ratio = 0.48-0.69; P < 0.05). Higher income was also associated with lower PC mortality but only in the control arm (risk ratio = 0.45-0.73; P < 0.05). There were no significant differences in SES gradient by arm (Pinteraction = 0.33 and Pinteraction = 0.47 for primary vs. secondary education and primary vs. tertiary education, respectively; Pinteraction = 0.65 and Pinteraction = 0.09 for low vs. intermediate income and low vs. high income, respectively; and Pinteraction = 0.27 among home ownership status strata). Substantial gradients by SES in PC incidence and mortality were observed in the control arm. Higher SES was associated with overdiagnosis of low-risk PC and, conversely, lower risk of incurable PC and lower PC mortality. Special attention should be directed toward recruiting men with low SES to participate in population-based cancer screening.
Collapse
|
14
|
Moses KA, Orom H, Brasel A, Gaddy J, Underwood W. Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter? Urology 2016; 99:76-83. [PMID: 27667157 DOI: 10.1016/j.urology.2016.07.045] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/07/2016] [Accepted: 07/23/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine if there are variations in the receipt of treatment based on race and disease severity. Treatment variations in men with prostate cancer (PCa) among the various racial groups in the United States exist, which may be a source of potential disparity in outcome. METHODS Utilizing Surveillance, Epidemiology and End Results 17, we identified 327,636 men diagnosed with PCa from 2004 to 2011. Logistic regression analysis was performed to determine the association of receiving definitive treatment and race in the context of disease severity. RESULTS African American (AA) and Hispanic men were less likely to receive treatment compared to White men (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.71, 0.75, and OR 0.95, 95% CI 0.92, 0.98, respectively). AA men had significantly lower OR of receiving definitive treatment within each D'Amico risk classification compared to White men, with decreasing odds of treatment for each increase in risk category (low-risk OR 0.81, 95% CI 0.78, 0.85; intermediate-risk OR 0.74, 95% CI 0.71, 0.77; and high-risk OR 0.62, 95% CI 0.58, 0.66). Hispanic men with intermediate-risk (OR 0.89, 95% CI 0.84, 0.94) or high-risk (OR 0.79, 95% CI 0.72, 0.85) disease had lower odds of receiving treatment compared to White men. Asian men had similar or greater odds of receiving treatment compared to White men within any Gleason or D'Amico classification. CONCLUSION There is a significant disparity in the receipt of treatment for PCa among AA and Hispanic men compared to White men. The variations in receipt of treatment reveal an area of opportunity to develop risk-stratified approaches to treatment regardless of ethnic identity, which may address the poorer PCa-related outcomes in these populations.
Collapse
Affiliation(s)
- Kelvin A Moses
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Alicia Brasel
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Jacquelyne Gaddy
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Willie Underwood
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY; Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| |
Collapse
|
15
|
Spratt DE, Chen YW, Mahal BA, Osborne JR, Zhao SG, Morgan TM, Palapattu G, Feng FY, Nguyen PL. Individual Patient Data Analysis of Randomized Clinical Trials: Impact of Black Race on Castration-resistant Prostate Cancer Outcomes. Eur Urol Focus 2016; 2:532-539. [PMID: 28723519 DOI: 10.1016/j.euf.2016.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/02/2016] [Accepted: 03/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Population data suggest that black men have a higher risk of dying from prostate cancer (PCa) than other racial ethnicities. OBJECTIVE To examine the impact of black race on progression-free survival (PFS) and overall survival (OS) among men with metastatic castration-resistant PCa (mCRPC) enrolled in randomized controlled trials (RCTs). DESIGN, SETTING, AND PARTICIPANTS A pooled analysis was performed on individual patient data from five modern PCa RCTs available from Project Data Sphere. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Adjusted hazard ratios (HRs) were calculated to compare black and white race regarding PFS and OS. Subgroup analyses of mCRPC trials were performed based on the control arm treatments (mitoxantrone or docetaxel). Relevant covariates were used for adjustment in all analyses. RESULTS AND LIMITATIONS A total of 1613 patients were included; 77 were black (4.7%). No significant differences between black and white men's baseline characteristics were noted regarding age, performance status, or pretreatment prostate-specific antigen. The pooled HRs for black race for OS and PFS were 1.01 (95% confidence interval [CI], 0.73-1.35) and 1.29 (95% CI, 0.95-1.76), respectively. The median OS for black compared with white men was 254 versus 238 d (p=0.92), respectively, with mitoxantrone and 581 versus 546 d (p=0.53), respectively, with docetaxel. The primary limitation was the relatively small number of black men enrolled in mCRPC clinical trials. CONCLUSIONS In the context of RCTs, in which patients receive generally uniform treatment, a significant difference in OS for black men could not be detected in mCRPC. Black men continue to be dramatically underrepresented in RCTs, and efforts are needed to increase minority accrual to these trials. PATIENT SUMMARY We looked at the outcomes of men treated in randomized controlled trials to determine the impact of black race on survival. We found that in the context of modern clinical trials, there does not appear to be a significant difference in survival between black and white races; however, a trend for greater progression in black men was noted.
Collapse
Affiliation(s)
- Daniel E Spratt
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, MI, USA.
| | - Yu-Wei Chen
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA
| | - Brandon A Mahal
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA
| | - Joseph R Osborne
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shuang G Zhao
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Ganesh Palapattu
- Department of Urology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
16
|
Fleisher L, Davis SN, Gross L, Bagden L, Zakrzewski D, González E, Kandadai V, Rusten C, Baskett J, Obeid E, Giri VN. Lessons Learned from Implementing a Prostate Cancer Risk Assessment Program for Underserved High-Risk Men in the Community: the Prostate REACH Project. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:191-197. [PMID: 25971432 DOI: 10.1007/s13187-015-0854-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Prostate cancer disproportionately affects Black men, who may also encounter barriers to participation in prostate cancer risk assessment. The Prostate Risk, Education and Assessment in the Community with Help (REACH) project was a community-based extension of a comprehensive prostate cancer risk assessment program at a comprehensive cancer center. The goals of the REACH project were the following: (1) establish a community prostate cancer risk assessment clinic, (2) conduct targeted recruitment, and (3) provide navigation services including follow-up for uninsured men. Key implementation steps included the following: (1) choosing a clinic site, (2) establishing patient access procedures, (3) establishing navigator services, (4) developing subsidy fund use guidelines, and (5) designing recruitment and promotion. Through community-based promotion, 64 men inquired about the program and 26 (41 %) participated. Of those screened, 46 % had abnormal results, and 2 men were diagnosed with prostate cancer. Here, we describe a unique demonstration project to implement a comprehensive prostate cancer risk assessment program in an underserved Black community and describe successes and challenges to inform future efforts to promote access to underserved men.
Collapse
Affiliation(s)
- Linda Fleisher
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Office of Health Communications and Health Disparities, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stacy N Davis
- Department of Health Outcomes and Behavior, Division of Population Sciences, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Laura Gross
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 1025 Walnut Street, Room 1015, Philadelphia, PA, 19107, USA
| | - Loretta Bagden
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Debra Zakrzewski
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Evelyn González
- Office of Health Communications and Health Disparities, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Venk Kandadai
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cheryl Rusten
- National Comprehensive Cancer Center, Fort Washington, PA, USA
| | - Jerilyn Baskett
- Office of Health Communications and Health Disparities, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elias Obeid
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Veda N Giri
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 1025 Walnut Street, Room 1015, Philadelphia, PA, 19107, USA.
| |
Collapse
|
17
|
Socioeconomic inequalities in prostate cancer survival: A review of the evidence and explanatory factors. Soc Sci Med 2015; 142:9-18. [PMID: 26281022 DOI: 10.1016/j.socscimed.2015.07.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/05/2015] [Accepted: 07/07/2015] [Indexed: 02/01/2023]
Abstract
Although survival rates after prostate cancer diagnosis have improved in the past two decades, survival analyses regarding the socioeconomic status (SES) suggest inequalities indicating worse prognosis for lower SES groups. An overview of the current literature is lacking and moreover, there is an ongoing discussion about the underlying causes but evidence is comparatively sparse. Several patient, disease and health care related factors are discussed to have an important impact on disparities in survival. Therefore, a systematic review was conducted to sum up the current evidence of survival inequalities and the contribution of different potential explanatory factors among prostate cancer patients. The PubMed database was screened for relevant articles published between January 2005 and September 2014 revealing 330 potentially eligible publications. After systematic review process, 46 papers met the inclusion criteria and were included in the review. About 75% of the studies indicate a significant association between low SES and worse survival among prostate cancer patients in the fully adjusted model. Overall, hazard ratios (low versus high SES) range from 1.02 to 3.57. A decrease of inequalities over the years was not identified. 8 studies examined the impact of explanatory factors on the association between SES and survival by progressive adjustment indicating mediating effects of comorbidity, stage at diagnosis and treatment modalities. Eventually, an apparent majority of the obtained studies indicates lower survival among patients with lower SES. The few studies that intend to explain inequalities found out instructive results regarding different contributing factors but evidence is still insufficient.
Collapse
|
18
|
Hicks EM, Litwin MS, Maliski SL. Latino men and familial risk communication about prostate cancer. Oncol Nurs Forum 2015; 41:509-16. [PMID: 25158656 DOI: 10.1188/14.onf.509-516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE/OBJECTIVES To investigate how familial communication about prostate cancer (PCa) risk and screening affects sons of men with PCa. RESEARCH APPROACH Qualitative grounded theory. SETTING Southern California. PARTICIPANTS 17 Latino sons of PCa survivors. METHODOLOGIC APPROACH The team conducted semistructured interviews and follow-up interviews. Therefore, the sample includes 25 transcripts. Data were analyzed with a mix of a priori topical codes and grounded theory techniques. FINDINGS Sons were in need of information about familial risk and screening options. They became sensitized to PCa, desired information, and held protective intentions. Hopeful intentions came up against cultural taboos around sex, reproductive health, and intimacy that limited discussions between fathers and sons. Fathers were a valued source of information but play various roles, which affect sons' screening intentions. Open communication between father and son promoted awareness of screening and familial risk. CONCLUSIONS Uncertainty about familial risk and screening options, especially early detection strategies, was exacerbated by cultural taboos around PCa. Fathers could have been primary and credible advocates for shared decision making, but sons had difficulty learning from their fathers' experience. INTERPRETATION FINDINGS from the study can help inform community-based interventions with Latino families, help to culturally tailor health messaging, and sensitize clinicians to a group that needs concerted counseling about PCa risk and screening.
Collapse
Affiliation(s)
| | - Mark S Litwin
- Department of Urology, University of California, Los Angeles
| | | |
Collapse
|
19
|
Maruthappu M, Watkins J, Taylor A, Williams C, Ali R, Zeltner T, Atun R. Unemployment and prostate cancer mortality in the OECD, 1990-2009. Ecancermedicalscience 2015; 9:538. [PMID: 26045715 PMCID: PMC4448991 DOI: 10.3332/ecancer.2015.538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Indexed: 02/01/2023] Open
Abstract
The global economic downturn has been associated with increased unemployment in many countries. Insights into the impact of unemployment on specific health conditions remain limited. We determined the association between unemployment and prostate cancer mortality in members of the Organisation for Economic Co-operation and Development (OECD). We used multivariate regression analysis to assess the association between changes in unemployment and prostate cancer mortality in OECD member states between 1990 and 2009. Country-specific differences in healthcare infrastructure, population structure, and population size were controlled for and lag analyses conducted. Several robustness checks were also performed. Time trend analyses were used to predict the number of excess deaths from prostate cancer following the 2008 global recession. Between 1990 and 2009, a 1% rise in unemployment was associated with an increase in prostate cancer mortality. Lag analysis showed a continued increase in mortality years after unemployment rises. The association between unemployment and prostate cancer mortality remained significant in robustness checks with 46 controls. Eight of the 21 OECD countries for which a time trend analysis was conducted, exhibited an estimated excess of prostate cancer deaths in at least one of 2008, 2009, or 2010, based on 2000-2007 trends. Rises in unemployment are associated with significant increases in prostate cancer mortality. Initiatives that bolster employment may help to minimise prostate cancer mortality during times of economic hardship.
Collapse
Affiliation(s)
| | - Johnathan Watkins
- Institute for Mathematical and Molecular Biomedicine, King's College London, London SE1 1UL, UK
| | - Abigail Taylor
- Medical Sciences Division, University of Oxford, OX1 2JD, UK
| | | | - Raghib Ali
- Cancer Epidemiology Unit, University of Oxford, Oxford OX3 7LF, UK ; Faculty of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, United Arab Emirates
| | - Thomas Zeltner
- Special Envoy for Financing to the Director General of the World Health Organization (WHO), 1211 Geneva 27, Switzerland ; University of Bern, Bern CH 3011, Switzerland
| | - Rifat Atun
- Faculty of Medicine, Imperial College London, London SW7 2AZ, UK ; Harvard School of Public Health, Harvard University, MA 02115, USA
| |
Collapse
|
20
|
Gupta A, Vernali S, Rand AE, Agarwal A, Qureshi MM, Hirsch AE. Effect of Patient Demographic Characteristics and Radiation Timing on PSA Reduction in Patients Treated With Definitive Radiation Therapy for Prostate Cancer. Clin Genitourin Cancer 2015; 13:364-369. [PMID: 25766484 DOI: 10.1016/j.clgc.2015.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/16/2015] [Accepted: 01/25/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this study was to assess how demographic characteristics and temporal factors including time to treatment (TTT) and elapsed time of treatment (ETT) affect prostate-specific antigen (PSA) levels during and after radiation treatment for low- and intermediate-risk prostate cancer. PATIENTS AND METHODS A retrospective review of 1584 patients was conducted on patients diagnosed with prostate cancer between 2005 and 2013, from which 147 patients were found to have completed definitive external beam radiation therapy (EBRT) monotherapy. Demographic data, TTT (days between diagnosis and EBRT start date), ETT (days between EBRT start and stop date), and Gleason score were collected on these patients and analysis of variance was performed to analyze the relationship of these factors with PSA changes. PSA changes were calculated during treatment as the difference between pre- and posttreatment PSA levels and after treatment as 3-year and overall PSA velocities. RESULTS Patients who spoke Haitian Creole (P = .039) and those with a longer ETT (P = .029) had significantly greater PSA decline during treatment, primarily as a result of higher pretreatment PSA levels. Patients with Gleason score 4+3 disease had significantly greater 3-year (P = .033) and overall (P = .019) PSA velocities. Race and/or ethnicity, insurance type, marital status, and age were not associated with any PSA variable. CONCLUSION Disparities in prostate cancer are not reflected in PSA dynamics during or after radiation treatment, but are evident in PSA level at presentation. Timeliness of treatment was not found to affect true PSA change due to EBRT in low- and intermediate-risk prostate cancer patients.
Collapse
Affiliation(s)
- Apar Gupta
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Steven Vernali
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Alexander E Rand
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Ankit Agarwal
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA.
| |
Collapse
|
21
|
Minority Use of a National Cancer Institute-Designated Comprehensive Cancer Center and Non-specialty Hospitals in Two Florida Regions. J Racial Ethn Health Disparities 2015; 2:373-84. [DOI: 10.1007/s40615-015-0084-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/04/2014] [Accepted: 01/05/2015] [Indexed: 02/07/2023]
|
22
|
Hararah MK, Pollack CE, Garza MA, Yeh HC, Markakis D, Phelan-Emrick DF, Wenzel J, Shapiro GR, Bone L, Johnson L, Ford JG. The Relationship Between Education and Prostate-Specific Antigen Testing Among Urban African American Medicare Beneficiaries. J Racial Ethn Health Disparities 2014; 2:176-83. [PMID: 26863336 DOI: 10.1007/s40615-014-0061-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/27/2014] [Accepted: 10/03/2014] [Indexed: 12/29/2022]
Abstract
PURPOSE We examined the association between socioeconomic status (SES) and prostate-specific antigen (PSA) cancer screening among older African American men. METHODS We analyzed baseline data from a sample of 485 community-dwelling African American men who participated in the Cancer Prevention and Treatment Demonstration Trial. The outcome was receipt of PSA screening within the past year. SES was measured using income and educational attainment. Sequential multivariate logistic regression models were performed to study whether health care access, patient-provider relationship, and cancer fatalism mediated the relationship between SES and PSA screening. RESULTS Higher educational attainment was significantly associated with higher odds of PSA screening in the past year (odds ratio (OR) 2.08 for college graduate compared to less than high school graduate, 95 % confidence interval (CI) 1.03-4.24); income was not. Health care access and patient-provider communication did not alter the relationship between education and screening; however, beliefs regarding cancer fatalism partially mediated the observed relationship. CONCLUSION Rates of prostate cancer screening among African American men vary by level of educational attainment; beliefs concerning cancer fatalism help explain this gradient. Understanding the determinants of cancer fatalism is a critical next step in building interventions that seek to ensure equitable access to prostate cancer screening.
Collapse
Affiliation(s)
| | - Craig Evan Pollack
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Mary A Garza
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Hsin-Chieh Yeh
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Diane Markakis
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Darcy F Phelan-Emrick
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Wenzel
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA.
| | - Gary R Shapiro
- Health Partners Cancer Program and Institute for Education and Research, Minneapolis, MN, USA. .,Institute for Advanced Studies in Aging (IASIA), Falls Church, VA, USA.
| | - Lee Bone
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Jean G Ford
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA.
| |
Collapse
|
23
|
Rand AE, Agarwal A, Ahuja D, Ngo T, Qureshi MM, Gupta A, Hirsch AE. Patient demographic characteristics and disease stage as drivers of disparities in mortality in prostate cancer patients who receive care at a safety net academic medical center. Clin Genitourin Cancer 2014; 12:455-60. [PMID: 24998045 DOI: 10.1016/j.clgc.2014.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/18/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The purpose of this study was to examine the effect of patient demographic characteristics and tumor stage at diagnosis on mortality in prostate cancer patients who receive care at a safety net, academic medical center with a diverse patient population. PATIENTS AND METHODS Eight hundred sixty-nine patients were diagnosed with prostate cancer at our institution between August 2004 and October 2011. Patient demographic characteristics were determined as follows: race and/or ethnicity, primary language, insurance type, age at diagnosis, marital status, income (determined by zip code), and American Joint Committee on Cancer (AJCC) tumor stage. Fisher exact or Pearson χ(2) test was used to test for differences in categorical variables. Multivariate logistic regression analysis was performed to identify factors related to mortality recorded at the end of follow-up in March of 2012. RESULTS Mortality was significantly decreased in patients who spoke Haitian Creole (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.04-0.74; P = .017). Distribution of insurance type, age, income, and prostate-specific antigen level differed between English and Haitian Creole speakers. Increased mortality was observed in patients who were single (OR, 1.99; 95% CI, 1.06-3.73; P = .032), older than 70 (OR, 15.5; 95% CI, 3.03-79.45; P = .001), had Medicaid and/or free care (OR, 4.98; 95% CI, 1.72-14.4; P = .003), or had AJCC stage IV cancer (OR, 9.56; 95% CI, 4.89-18.69; P < .001). There was no significant difference in mortality according to race and/or ethnicity or income in the multivariate-adjusted model. CONCLUSION In this retrospective study, prostate cancer patients who spoke Haitian Creole had a lower incidence of mortality compared with English speakers. Consistent with similar large-scale studies, being single or having Medicaid and/or free care insurance predicted worse outcomes, reinforcing their roles as drivers of disparities.
Collapse
Affiliation(s)
- Alexander E Rand
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Ankit Agarwal
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Divya Ahuja
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Taylor Ngo
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Apar Gupta
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA.
| |
Collapse
|
24
|
Sharp L, Donnelly D, Hegarty A, Carsin AE, Deady S, McCluskey N, Gavin A, Comber H. Risk of several cancers is higher in urban areas after adjusting for socioeconomic status. Results from a two-country population-based study of 18 common cancers. J Urban Health 2014; 91:510-25. [PMID: 24474611 PMCID: PMC4074316 DOI: 10.1007/s11524-013-9846-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Some studies suggest that there are urban-rural variations in cancer incidence but whether these simply reflect urban-rural socioeconomic variation is unclear. We investigated whether there were urban-rural variations in the incidence of 18 cancers, after adjusting for socioeconomic status. Cancers diagnosed between 1995 and 2007 were extracted from the population-based National Cancer Registry Ireland and Northern Ireland Cancer Registry and categorised by urban-rural status, based on population density of area of residence at diagnosis (rural <1 person per hectare, intermediate 1-15 people per hectare, urban >15 people per hectare). Relative risks (RR) were calculated by negative binomial regression, adjusting for age, country and three area-based markers of socioeconomic status. Risks were significantly higher in both sexes in urban than rural residents with head and neck (males RR urban vs. rural = 1.53, 95 % CI 1.42-1.64; females RR = 1.29, 95 % CI 1.15-1.45), esophageal (males 1.21, 1.11-1.31; females 1.21, 1.08-1.35), stomach (males 1.36, 1.27-1.46; females 1.19, 1.08-1.30), colorectal (males 1.14, 1.09-1.18; females 1.04, 1.00-1.09), lung (males 1.54, 1.47-1.61; females 1.74, 1.65-1.84), non-melanoma skin (males 1.13, 1.10-1.17; females 1.23, 1.19-1.27) and bladder (males 1.30, 1.21-1.39; females 1.31, 1.17-1.46) cancers. Risks of breast, cervical, kidney and brain cancer were significantly higher in females in urban areas. Prostate cancer risk was higher in rural areas (0.94, 0.90-0.97). Other cancers showed no significant urban-rural differences. After adjusting for socioeconomic variation, urban-rural differences were evident for 12 of 18 cancers. Variations in healthcare utilization and known risk factors likely explain some of the observed associations. Explanations for others are unclear and, in the interests of equity, warrant further investigation.
Collapse
Affiliation(s)
- Linda Sharp
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland,
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Aarestrup J, Gamborg M, Cook MB, Sørensen TIA, Baker JL. Childhood body mass index and the risk of prostate cancer in adult men. Br J Cancer 2014; 111:207-12. [PMID: 24867696 PMCID: PMC4090733 DOI: 10.1038/bjc.2014.266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/09/2014] [Accepted: 04/24/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Prostate cancer aetiology is poorly understood. It may have origins early in life; previously we found a positive association with childhood height. The effects of early life body mass index (BMI; kg m(-2)) on prostate cancer remain equivocal. We investigated if childhood BMI, independently and adjusted for height, is positively associated with adult prostate cancer. METHODS Subjects were a cohort of 125208 boys formed from the Copenhagen School Health Records Register, born 1930-1969 with height and weight measurements at 7-13 years. Cases were identified through linkage to the Danish Cancer Registry. Cox proportional hazards regressions were performed. RESULTS Overall, 3355 men were diagnosed with prostate cancer. Body mass index during childhood was positively associated with adult prostate cancer. The hazard ratio of prostate cancer was 1.06 (95% confidence interval (CI): 1.01-1.10) per BMI z-score at age 7, and 1.05 (95% CI: 1.01-1.10) per BMI z-score at age 13. Estimates were similar and significant at all other ages. However, adjustment for childhood height attenuated the associations at all but the youngest ages as most estimates became nonsignificant. CONCLUSIONS These results suggest that at most childhood ages, BMI does not confer an additional risk for prostate cancer beyond that of height.
Collapse
Affiliation(s)
- J Aarestrup
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Nordre Fasanvej 5, Frederiksberg, 2000 Copenhagen, Denmark
| | - M Gamborg
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Nordre Fasanvej 5, Frederiksberg, 2000 Copenhagen, Denmark
| | - M B Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 7-E106, MSC 9774, Bethesda, MD 20892-9774, USA
| | - T I A Sørensen
- 1] Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Nordre Fasanvej 5, Frederiksberg, 2000 Copenhagen, Denmark [2] Novo Nordisk Foundation Center for Basic Metabolic Research, Section on Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen 1, 1. Floor, 2100 Copenhagen, Denmark
| | - J L Baker
- 1] Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Nordre Fasanvej 5, Frederiksberg, 2000 Copenhagen, Denmark [2] Novo Nordisk Foundation Center for Basic Metabolic Research, Section on Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen 1, 1. Floor, 2100 Copenhagen, Denmark
| |
Collapse
|
26
|
Impact of Comorbidity, Race, and Marital Status in Men Referred for Prostate Biopsy with PSA >20 ng/mL: A Pilot Study in High-Risk Patients. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:362814. [PMID: 27355056 PMCID: PMC4897532 DOI: 10.1155/2014/362814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 06/14/2014] [Accepted: 06/15/2014] [Indexed: 11/17/2022]
Abstract
Objective. To assess the impact of comorbidity, race, and marital status on overall survival (OS) among men presenting for prostate biopsy with PSA >20 ng/mL. Methods. Data were reviewed from 2000 to 2012 and 78 patients were included in the cohort. We analyzed predictors of OS using a Cox proportional hazards model and the association between Charlson Comorbidity Index (CCI) score and PCa diagnosis or high-grade cancer using logistic regression and multinomial regression models, respectively. Results. The median age of patients was 62.5 (IQR 57–73) years. Median CCI was 3 (IQR 2–4), 69% of patients were African American men, 56% of patients were married, and 85% of patients had a positive biopsy. CCI (HR 1.52, 95% CI 1.19, 1.94), PSA (HR 1.62, 95% CI 1.09, 2.42), and Gleason sum (HR 2.04, 95% CI 1.17, 3.56) were associated with OS. CCI was associated with Gleason sum 7 (OR 4.06, 95% CI 1.04, 15.89) and Gleason sum 8–10 (OR 4.52, 95% CI 1.16, 17.54) PCa. Conclusions. CCI is an independent predictor of high-grade disease and worse OS among men with PCa. Race and marital status were not significantly associated with survival in this cohort. Patient comorbidity is an important component of determining the optimal approach to management of prostate cancer.
Collapse
|
27
|
Systematic review of the evidence of a relationship between chronic psychosocial stress and C-reactive protein. Mol Diagn Ther 2013; 17:147-64. [PMID: 23615944 DOI: 10.1007/s40291-013-0026-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION C-reactive protein (CRP) is an acute-phase reactant with an increasing number of clinical functions. Studies in recent years have identified several social, economic, demographic, and psychological factors that contribute to baseline inflammation. Psychosocial stress represents a significant contributor to baseline inflammation. Given the importance of understanding background drivers of CRP levels, we conducted this review to assess the impact of chronic psychosocial stress on CRP levels. METHODS Medline was searched through February 2013 for human studies examining CRP levels with respect to chronic psychosocial stress. RESULTS The initial search identified 587 articles from which 129 potentially appropriate articles were reviewed. Of these 129 articles, 41 articles were included in the review. These studies were published between 2003 and 2013. Of these studies, 6 analyzed employment stress, 2 analyzed unemployment stress, 6 analyzed burnout and vital exhaustion, 6 analyzed caregiver stress, 3 analyzed interpersonal stress, 17 analyzed socioeconomic position, and 2 analyzed discrimination. CONCLUSION We conclude that psychosocial stress significantly impacts CRP and should be considered when interpreting the meaning of CRP elevations.
Collapse
|
28
|
Vidal AC, Tucker C, Schildkraut JM, Richardson RM, McPhail M, Freedland SJ, Hoyo C, Grant DJ. Novel associations of UDP-glucuronosyltransferase 2B gene variants with prostate cancer risk in a multiethnic study. BMC Cancer 2013; 13:556. [PMID: 24267955 PMCID: PMC3924347 DOI: 10.1186/1471-2407-13-556] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 11/20/2013] [Indexed: 12/22/2022] Open
Abstract
Background We have previously shown that a functional polymorphism of the UGT2B15 gene (rs1902023) was associated with increased risk of prostate cancer (PC). Novel functional polymorphisms of the UGT2B17 and UGT2B15 genes have been recently characterized by in vitro assays but have not been evaluated in epidemiologic studies. Methods Fifteen functional SNPs of the UGT2B17 and UGT2B15 genes, including cis-acting UGT2B gene SNPs, were genotyped in African American and Caucasian men (233 PC cases and 342 controls). Regression models were used to analyze the association between SNPs and PC risk. Results After adjusting for race, age and BMI, we found that six UGT2B15 SNPs (rs4148269, rs3100, rs9994887, rs13112099, rs7686914 and rs7696472) were associated with an increased risk of PC in log-additive models (p < 0.05). A SNP cis-acting on UGT2B17 and UGT2B15 expression (rs17147338) was also associated with increased risk of prostate cancer (OR = 1.65, 95% CI = 1.00-2.70); while a stronger association among men with high Gleason sum was observed for SNPs rs4148269 and rs3100. Conclusions Although small sample size limits inference, we report novel associations between UGT2B15 and UGT2B17 variants and PC risk. These associations with PC risk in men with high Gleason sum, more frequently found in African American men, support the relevance of genetic differences in the androgen metabolism pathway, which could explain, in part, the high incidence of PC among African American men. Larger studies are required.
Collapse
Affiliation(s)
- Adriana C Vidal
- Department of Biology and Cancer Research Program, JLC-Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, NC 27707, USA.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Ribeiro ADA, Nardocci AC. Desigualdades socioeconômicas na incidência e mortalidade por câncer: revisão de estudos ecológicos, 1998-2008. SAUDE E SOCIEDADE 2013. [DOI: 10.1590/s0104-12902013000300020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: Desigualdades socioeconômicas se manifestam na incidência e mortalidade por neoplasias malignas. Estudos ecológicos representam abordagem essencial em epidemiologia e podem contribuir na investigação dos determinantes sociais dos eventos em saúde. OBJETIVO: Investigar associações entre nível socioeconômico e incidência e mortalidade por câncer e seus tipos, através de revisão de estudos ecológicos. Definir a real importância desempenhada pelos estudos ecológicos na investigação dessa relação. MÉTODO: As principais bases de dados regionais e internacionais foram pesquisadas na seleção de artigos em português, espanhol e inglês, publicados entre 1998 e 2008. RESULTADOS: 32 estudos elegíveis foram incluídos. Verificou-se associação positiva e consistente do nível socioeconômico da área de residência com incidência de câncer de próstata e mortalidade pelo de cólon nos homens, e com incidência e mortalidade por câncer de mama e mortalidade pelo de cólon nas mulheres. Associação consistente e negativa foi encontrada para incidência e mortalidade por cânceres de esôfago e estômago, para incidência dos de cólon e pulmão e mortalidade pelos de laringe e cavidade oral, nos homens, e para incidência e a mortalidade pelos de esôfago, estômago e colo uterino e para incidência dos de cólon e pulmão, nas mulheres. CONCLUSÃO: Apesar da presença de efeito residual de área e de viés relacionado à medida agregada de nível socioeconômico, estudos ecológicos podem ser eficientemente utilizados na mensuração das desigualdades socioeconômicas em câncer. Uso de pequenas unidades geográficas e de dados de registros de câncer em países em desenvolvimento pode contribuir para melhor conhecimento de suas desigualdades em saúde.
Collapse
|
30
|
Stokes WA, Hendrix LH, Royce TJ, Allen IM, Godley PA, Wang AZ, Chen RC. Racial differences in time from prostate cancer diagnosis to treatment initiation: a population-based study. Cancer 2013; 119:2486-93. [PMID: 23716470 DOI: 10.1002/cncr.27975] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 10/27/2012] [Accepted: 11/27/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Timely delivery of care has been identified by the Institute of Medicine as an indicator for quality health care, and treatment delay is a potentially modifiable obstacle that can contribute to the disparities among African American (AA) and Caucasian patients in prostate cancer recurrence and mortality. Using the Surveillance, Epidemiologic and End Results (SEER)-Medicare linked database, we compared time from diagnosis to treatment in AA and Caucasian prostate cancer patients. METHODS A total of 2506 AA and 21,454 Caucasian patients diagnosed with localized prostate cancer from 2004 through 2007 and treated within 12 months were included. Linear regression was used to assess potential differences in time to treatment between AA and Caucasian patients, after adjusting for sociodemographic and clinical covariates. RESULTS Time from diagnosis to definitive (prostatectomy and radiation) treatment was longer for AA patients in all risk groups, and most pronounced in high-risk cancer (96 versus 105 days, P < .001). On multivariate analysis, racial differences to any and definitive treatment persisted (β = 7.3 and 7.6, respectively, for AA patients). Delay to definitive treatment was longer in high-risk (versus low-risk) disease and in more recent years. CONCLUSIONS AA patients with prostate cancer experienced longer time from diagnosis to treatment than Caucasian patients with prostate cancer. AA patients appear to experience disparities across all aspects of this disease process, and together these factors in receipt of care plausibly contribute to the observed differences in rates of recurrence and mortality among AA and Caucasian patients with prostate cancer.
Collapse
Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27516, USA
| | | | | | | | | | | | | |
Collapse
|
31
|
Parent MÉ, Goldberg MS, Crouse DL, Ross NA, Chen H, Valois MF, Liautaud A. Traffic-related air pollution and prostate cancer risk: a case-control study in Montreal, Canada. Occup Environ Med 2013; 70:511-8. [PMID: 23531743 DOI: 10.1136/oemed-2012-101211] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES There is a paucity of information on environmental risk factors for prostate cancer. We conducted a case-control study in Montreal to estimate associations with exposure to ground-level nitrogen dioxide (NO2), a marker for traffic-related air pollution. METHODS Cases were 803 men with incident prostate cancer, ≤75 years of age, and diagnosed across all French hospitals in Montreal. Concurrently, 969 controls were drawn from electoral lists of French-speaking individuals residing in the same electoral districts as the cases and frequency-matched by age. Concentrations of NO2 were measured across Montreal in 2005-2006. We developed a land use regression model to predict concentrations of NO2 across Montreal for 2006. These estimates were back-extrapolated to 1996. Estimates were linked to residential addresses at the time of diagnosis or interview. Unconditional logistic regression was used, adjusting for potential confounding variables. RESULTS For each increase of 5 parts per billion of NO2, as estimated from the original land use regression model in 2006, the OR5ppb adjusted for personal factors was 1.44 (95% CI 1.21 to 1.73). Adding in contextual factors attenuated the OR5ppb to 1.27 (95% CI 1.03 to 1.58). One method for back-extrapolating concentrations of NO2 to 1996 (about 10 years before the index date) gave the following OR5ppb: 1.41 (95% CI 1.24 to 1.62) when personal factors were included, and 1.30 (95% CI 1.11 to 1.52) when contextual factors were added. CONCLUSIONS Exposure to ambient concentrations of NO2 at the current address was associated with an increased risk of prostate cancer. This novel finding requires replication.
Collapse
Affiliation(s)
- Marie-Élise Parent
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Université du Québec, Laval, Québec, Canada.
| | | | | | | | | | | | | |
Collapse
|
32
|
Wirén SM, Drevin LI, Carlsson SV, Akre O, Holmberg EC, Robinson DE, Garmo HG, Stattin PE. Fatherhood status and risk of prostate cancer: nationwide, population-based case-control study. Int J Cancer 2013; 133:937-43. [PMID: 23354735 PMCID: PMC3734704 DOI: 10.1002/ijc.28057] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 12/21/2012] [Indexed: 11/06/2022]
Abstract
Previous studies have shown a decreased risk of prostate cancer for childless men; however, the cause of the association remains to be elucidated. The aim of our study was to assess the risk of prostate cancer by fatherhood status, also considering potential confounding factors. In a case-control study in Prostate Cancer data Base Sweden 2.0, a nationwide, population-based cohort, data on number of children, marital status, education, comorbidity and tumor characteristics obtained through nationwide healthcare registers and demographic databases for 117,328 prostate cancer cases and 562,644 controls, matched on birth year and county of residence, were analyzed. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for prostate cancer overall and by risk category, adjusting for marital status and education. Childless men had a decreased risk of prostate cancer compared to fathers, OR = 0.83 (95% CI = 0.82-0.84), and risk was lower for low-risk prostate cancer, OR = 0.74 (95% CI = 0.72-0.77), than for metastatic prostate cancer, OR = 0.93 (95% CI = 0.90-0.97). Adjustment for marital status and education attenuated the association in the low-risk category, adjusted OR = 0.87 (95% CI = 0.84-0.91), whereas OR for metastatic cancer remained virtually unchanged, adjusted OR = 0.92 (95% CI = 0.88-0.96). Our data indicate that the association between fatherhood status and prostate cancer to a large part is due to socioeconomic factors influencing healthcare-seeking behavior including testing of prostate-specific antigen levels.
Collapse
Affiliation(s)
- Sara M Wirén
- Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Rohani-Rasaf M, Moradi-Lakeh M, Ramezani R, Asadi-Lari M. Measuring socioeconomic disparities in cancer incidence in Tehran, 2008. Asian Pac J Cancer Prev 2013; 13:2955-60. [PMID: 22938489 DOI: 10.7314/apjcp.2012.13.6.2955] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health disparities exist among and within countries, while developing and low income countries suffer more. The aim of this study was to quantify cancer disparities with regard to socioeconomic position (SEP) in 22 districts of Tehran, Iran. METHOD According to the national cancer registry, 7599 new cancer cases were recorded within 22 districts of Tehran in 2008. Based on combined data from census and a population-based health equity study (Urban HEART), socioeconomic position (SEP) was calculated for each district. Index of disparity, absolute and relative concentration indices (ACI and RCI) were used for measuring disparities in cancer incidence. RESULTS The overall cancer age standardised rate (ASR) was 117.2 per 100,000 individuals (120.4 for men and 113.5 for women). Maximum ASR in both genders was seen in districts 6, 3, 1 and 2. Breast, colorectal, stomach, skin and prostate were the most common cancers. Districts with higher SEP had higher ASR (r=0.9, p<0.001). Positive ACI and RCI indicated that cancer cases accumulated in districts with high SEP. Female disparity was greater than for men in all measures. Breast, colorectal, prostate and bladder ASR ascended across SEP groups. Negative ACI and RCI in cervical and skin cancers in women indicate their aggregation in lower SEP groups. Breast cancer had the highest absolute disparities measure. CONCLUSION This report provides an appropriate guide and new evidence on disparities across geographical, demographic and particular SEP groups. Higher ASR in specific districts warrants further research to investigate the background predisposing factors.
Collapse
Affiliation(s)
- Marzieh Rohani-Rasaf
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | |
Collapse
|
34
|
Major JM, Norman Oliver M, Doubeni CA, Hollenbeck AR, Graubard BI, Sinha R. Socioeconomic status, healthcare density, and risk of prostate cancer among African American and Caucasian men in a large prospective study. Cancer Causes Control 2012; 23:1185-91. [PMID: 22674292 PMCID: PMC3405544 DOI: 10.1007/s10552-012-9988-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The purpose of this study was to separately examine the impact of neighborhood socioeconomic deprivation and availability of healthcare resources on prostate cancer risk among African American and Caucasian men. METHODS In the large, prospective NIH-AARP Diet and Health Study, we analyzed baseline (1995-1996) data from adult men, aged 50-71 years. Incident prostate cancer cases (n = 22,523; 1,089 among African Americans) were identified through December 2006. Lifestyle and health risk information was ascertained by questionnaires administered at baseline. Area-level socioeconomic indicators were ascertained by linkage to the US Census and the Area Resource File. Multilevel Cox models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). RESULTS A differential effect among African Americans and Caucasians was observed for neighborhood deprivation (p-interaction = 0.04), percent uninsured (p-interaction = 0.02), and urologist density (p-interaction = 0.01). Compared to men living in counties with the highest density of urologists, those with fewer had a substantially increased risk of developing advanced prostate cancer (HR = 2.68, 95 % CI = 1.31, 5.47) among African American. CONCLUSIONS Certain socioeconomic indicators were associated with an increased risk of prostate cancer among African American men compared to Caucasians. Minimizing differences in healthcare availability may be a potentially important pathway to minimizing disparities in prostate cancer risk.
Collapse
Affiliation(s)
- Jacqueline M Major
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD 20852, USA.
| | | | | | | | | | | |
Collapse
|
35
|
Krieger N, Chen JT, Kosheleva A, Waterman PD. Shrinking, widening, reversing, and stagnating trends in US socioeconomic inequities in cancer mortality for the total, black, and white populations: 1960-2006. Cancer Causes Control 2012; 23:297-319. [PMID: 22116539 PMCID: PMC3262111 DOI: 10.1007/s10552-011-9879-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 11/10/2011] [Indexed: 01/18/2023]
Abstract
OBJECTIVES OF STUDY To test recent claims that cancer inequities are bound to increase as population health improves. METHODS We analyzed 1960-2006 age-standardized US county cancer mortality data, total and site-specific (lung, prostate, colorectal, breast, cervix, stomach), stratified by county income quintile for the US total, black, and white populations. RESULTS Between 1960 and 2006, US socioeconomic inequities in cancer mortality variously shrunk, widened, reversed, and stagnated, depending on time period and cancer site. For all cancers combined and most, but not all, sites, absolute, but not relative, socioeconomic gaps were greater for the black compared to white population. Compared to the yearly age-specific mortality rates among whites in the most affluent counties, the percent of excess cancer deaths among whites in the lower four county income quintiles first rose above 0 in 1990 and in 2006 equaled 5.4% (95% CI 4.8, 6.0); among blacks, it rose from 6.0% (95% CI 4.5, 7.4) in 1960 to 24.7% (95% CI 23.9, 25.5) in 1990 and remained at this level through 2006. CONCLUSIONS The hypothesis that cancer mortality inequities are bound to increase is refuted by long-term data on total and site-specific cancer mortality stratified by socioeconomic position and race/ethnicity.
Collapse
Affiliation(s)
- Nancy Krieger
- Department of Society, Human Development and Health (SHDH), Harvard School of Public Health (HSPH), Boston, MA 02115, USA.
| | | | | | | |
Collapse
|
36
|
Pollack CE, Bekelman JE, Liao KJ, Armstrong K. Hospital racial composition and the treatment of localized prostate cancer. Cancer 2011; 117:5569-78. [PMID: 21692067 PMCID: PMC3759984 DOI: 10.1002/cncr.26232] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/10/2011] [Accepted: 04/12/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Racial differences in the treatment of men with localized prostate cancer remain poorly understood. This study examines whether hospital racial composition is associated with the type of treatment black and white men receive. METHODS The authors performed a retrospective cohort study of men in Surveillance, Epidemiology, and End Results-Medicare diagnosed with localized prostate cancer from 1995 to 2005 linked to hospital and census data. A total of 134,291 men were assigned to the hospital where they received care. Generalized estimating equations were used to determine whether hospital racial composition was associated with the receipt of definitive therapy and type of treatment. RESULTS Black men were less likely to receive radiation and/or prostatectomy compared with white men (55.5% vs 63.7%, P < .001) and, among those who received definitive therapy, were less likely to undergo prostatectomy (27.5% vs 31.9%, P < .001). The percentage of black men who received their care at hospitals with a high proportion of black patients was 48.0%, compared with only 5.2% of white patients who received care in this subset of hospitals. Men were significantly less likely to receive definitive treatment (odds ratio, 0.81; 95% confidence interval, 0.74-0.90) in hospitals with a high proportion of black patients compared with men seen at hospitals with fewer black patients. The association between hospital racial composition and treatment did not significantly differ by patient race. CONCLUSIONS Hospital racial composition is consistently associated with the care that men receive for localized prostate cancer. Better understanding of the factors that determine where men receive care is an important component in reducing variation in treatment.
Collapse
Affiliation(s)
- Craig Evan Pollack
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
| | | | | | | |
Collapse
|
37
|
Pollack CE, Weissman G, Bekelman J, Liao K, Armstrong K. Physician social networks and variation in prostate cancer treatment in three cities. Health Serv Res 2011; 47:380-403. [PMID: 22092259 DOI: 10.1111/j.1475-6773.2011.01331.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine whether physician social networks are associated with variation in treatment for men with localized prostate cancer. DATA SOURCE 2004-2005 Surveillance, Epidemiology and End Results-Medicare data from three cities. STUDY DESIGN We identified the physicians who care for patients with prostate cancer and created physician networks for each city based on shared patients. Subgroups of urologists were defined as physicians with dense connections with one another via shared patients. PRINCIPAL FINDINGS Subgroups varied widely in their unadjusted rates of prostatectomy and the racial/ethnic and socioeconomic composition of their patients. There was an association between urologist subgroup and receipt of prostatectomy. In city A, four subgroups had significantly lower odds of prostatectomy compared with the subgroup with the highest rates of prostatectomy after adjusting for patient clinical and sociodemographic characteristics. Similarly, in cities B and C, subgroups had significantly lower odds of prostatectomy compared with the baseline. CONCLUSIONS Using claims data to identify physician networks may provide an insight into the observed variation in treatment patterns for men with prostate cancer.
Collapse
Affiliation(s)
- Craig Evan Pollack
- Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | |
Collapse
|
38
|
Wan N, Zhan FB, Cai Z. Socioeconomic disparities in prostate cancer mortality and the impact of geographic scale. South Med J 2011; 104:553-9. [PMID: 21886062 DOI: 10.1097/smj.0b013e31821f99ff] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine socioeconomic disparities in prostate cancer mortality and to assess the scale effect on the results of the disparity analysis. METHODS Using prostate cancer mortality data (N = 14,036) of Texas from 1996 to 2004, this study examines the variations of socioeconomic disparities in prostate cancer mortality across different geographic scales. Age-adjusted odds ratios are employed to reveal the disparities by single and composite socioeconomic indicators at county, census tract, and block group levels. RESULTS The analysis shows that (1) disparities in prostate cancer mortality are significant for most socioeconomic indicators, (2) area-level socioeconomic indicators tend to reveal a less extent of disparity than individual-level indicators do, and (3) socioeconomic disparities in prostate cancer mortality at the census tract and block group levels are similar to each other but are completely different from those at the county level. CONCLUSION The selection of geographic scale and socioeconomic indicators affects the results of socioeconomic disparity analysis in prostate cancer mortality. Most census tract and block group level socioeconomic indicators are appropriate for analyzing disparities in prostate cancer mortality. County level socioeconomic indicators should be avoided if possible.
Collapse
Affiliation(s)
- Neng Wan
- Texas State University-San Marcos, Department of Geography, San Marcos, TX 78666, USA.
| | | | | |
Collapse
|
39
|
Srougi V, Antunes AA, T S, Reis, Dall'Oglio MF, Nesrallah AJ, Leite KRM, Srougi M. Socioeconomic status is an independent predictor of biochemical recurrence among patients with prostate cancer who undergo radical prostatectomy. Int Braz J Urol 2011; 37:507-13. [DOI: 10.1590/s1677-55382011000400010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2011] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Sabrina T
- University of Sao Paulo Medical School, Brazil
| | - Reis
- University of Sao Paulo Medical School, Brazil
| | | | | | | | | |
Collapse
|
40
|
Freeman VL, Ricardo AC, Campbell RT, Barrett RE, Warnecke RB. Association of census tract-level socioeconomic status with disparities in prostate cancer-specific survival. Cancer Epidemiol Biomarkers Prev 2011; 20:2150-9. [PMID: 21784953 DOI: 10.1158/1055-9965.epi-11-0344] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Social determinants of prostate cancer survival and their relation to racial/ethnic disparities thereof are poorly understood. We analyzed whether census tract-level socioeconomic status (SES) at diagnosis is a prognostic factor in men with prostate cancer and helps explain racial/ethnic disparities in survival. METHODS We used a retrospective cohort of 833 African American and white, non-Hispanic men diagnosed with prostate cancer at four Chicago area medical centers between 1986 and 1990. Tract-level concentrated disadvantage (CD), a multidimensional area-based measure of SES, was calculated for each case, using the 1990 U.S. census data. Its association with prostate cancer-specific survival was measured by using Cox proportional hazard models adjusted for case and tumor characteristics, treatment, and health care system [private sector vs. Veterans Health Administration (VA)]. RESULTS Tract-level CD associated with an increased risk of death from prostate cancer (highest vs. lowest quartile, HR = 2.37, P < 0.0001). However, the association was observed in the private sector and not in the VA (per 1 SD increase, HR = 1.33, P < 0.0001 and HR = 0.93, P = 0.46, respectively). The multivariate HR for African Americans before and after accounting for tract-level CD was 1.30 (P = 0.0036) and 0.96 (P = 0.82), respectively. CONCLUSIONS Census tract-level SES is a social determinant of prostate-specific mortality and helps account for racial/ethnic disparities in survival. An equal-access health care system may moderate this association. IMPACT This study identifies a potential pathway for minimizing disparities in prostate cancer control. The findings need confirmation in a population-based study.
Collapse
Affiliation(s)
- Vincent L Freeman
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL 60637, USA.
| | | | | | | | | |
Collapse
|
41
|
Abstract
This paper provides a synthesis on socioeconomic inequalities in cancer incidence, mortality and survival across countries and within countries, with particular focus on the Italian context; the paper also describes the underlying mechanisms documented for cancer incidence, and reports some remarks on policies to tackle inequalities.From a worldwide perspective, the burden of cancer appears to be particularly increasing in developing countries, where many cancers with a poor prognosis (liver, stomach and oesophagus) are much more common than in richer countries. As in the case of incidence and mortality, also in cancer survival we observe a great variability across countries. Different studies have suggested a possible impact of health care on the social gradients in cancer survival, even in countries with a National Health System providing equitable access to care.In developed countries, there is increasing awareness of social inequalities as an important public health issue; as a consequence, there is a variety of strategies and policies being implemented throughout Europe. However, recent reviews emphasize that present knowledge on effectiveness of policies and interventions on health inequalities is not sufficient to offer a robust and evidence-based guide to the choice and design of interventions, and that more evaluation studies are needed.The large disparities in health that we can measure within and between countries represent a challenge to the world; social health inequalities are avoidable, and their reduction therefore represents an achievable goal and an ethical imperative.
Collapse
Affiliation(s)
- Franco Merletti
- Center for Cancer Prevention, University of Turin, San Giovanni Battista University Hospital, Italy.
| | | | | |
Collapse
|
42
|
Do YK, Carpenter WR, Spain P, Clark JA, Hamilton RJ, Galanko JA, Jackman A, Talcott JA, Godley PA. Race, healthcare access and physician trust among prostate cancer patients. Cancer Causes Control 2009; 21:31-40. [PMID: 19777359 DOI: 10.1007/s10552-009-9431-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 09/09/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the effect of healthcare access and other characteristics on physician trust among black and white prostate cancer patients. METHODS A three-timepoint follow-up telephone survey after cancer diagnosis was conducted. This study analyzed data on 474 patients and their 1,320 interviews over three time periods. RESULTS Among other subpopulations, black patients who delayed seeking care had physician trust levels that were far lower than that of both Caucasians as well as that of the black patients overall. Black patients had greater variability in their levels of physician trust compared to their white counterparts. CONCLUSIONS Both race and access are important in explaining overall lower levels and greater variability in physician trust among black prostate cancer patients. Access barriers among black patients may spill over to the clinical encounter in the form of less physician trust, potentially contributing to racial disparities in treatment received and subsequent outcomes. Policy efforts to address the racial disparities in prostate cancer should prioritize improving healthcare access among minority groups.
Collapse
Affiliation(s)
- Young Kyung Do
- Department of Health Policy and Management, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC 27599-7411, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Jeffreys M, Sarfati D, Stevanovic V, Tobias M, Lewis C, Pearce N, Blakely T. Socioeconomic inequalities in cancer survival in New Zealand: the role of extent of disease at diagnosis. Cancer Epidemiol Biomarkers Prev 2009; 18:915-21. [PMID: 19223561 DOI: 10.1158/1055-9965.epi-08-0685] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined socioeconomic inequalities in cancer survival in New Zealand among 132,006 people ages 15 to 99 years who had a cancer registered (1994-2003) and were followed up to 2004. Relative survival rates (RSR) were calculated using deprivation-specific life tables. A census-based measure of socioeconomic position (New Zealand deprivation based on the 1996 census) based on residence at the time of cancer registration was used. All RSRs were age-standardized, and further standardization was used to investigate the effect of extent of disease at diagnosis on survival. Weighted linear regression was used to estimate the deprivation gap (slope index of inequality) between the most and least deprived cases. Socioeconomic inequalities in cancer survival were evident for all of the major cancer sites, with the deprivation gap being particularly high for prostate (-0.15), kidney and uterus (both -0.14), bladder (-0.12), colorectum (-0.10), and brain (+0.10). Accounting for extent of disease explained some of the inequalities in survival from breast and colorectal cancer and melanoma and all of the deprivation gaps in survival of cervical cancer; however, it did not affect RSRs for cancers of the kidney, uterus, and brain. No substantial differences between the total compared with the non-Māori population were found, indicating that the findings were not due to confounding by ethnicity. In summary, socioeconomic disparities in survival were consistent for nearly all cancer sites, persisted in ethnic-specific analyses, and were only partially explained by differential extent of disease at diagnosis. Further investigation of reasons for persisting inequalities is required.
Collapse
Affiliation(s)
- Mona Jeffreys
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whately Road, Bristol BS8 2PS, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
44
|
Miller DC, Litwin MS, Bergman J, Stepanian S, Connor SE, Kwan L, Aronson WJ. Prostate cancer severity among low income, uninsured men. J Urol 2008; 181:579-83; discussion 583-4. [PMID: 19100580 DOI: 10.1016/j.juro.2008.10.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE The proportion of American men with organ confined, low risk prostate cancer has increased significantly during the last 2 decades. Whether this trend also applies to men at the extremes of socioeconomic disadvantage remains unknown. Therefore, we evaluated trends in prostate cancer severity in an ethnically diverse cohort of low income, uninsured men served by a state funded public health program in California. MATERIALS AND METHODS We performed a retrospective cohort study of 570 disadvantaged men enrolled in the California program from 2001 through 2006. Using routinely collected clinical variables we defined 2 measures of cancer severity as 1) the proportion of enrollees with metastases at diagnosis and 2) the proportions of men with nonmetastatic tumors whose cancers had low, intermediate or high risk features at diagnosis. We performed bivariate analyses to assess time trends in cancer severity. RESULTS Prostate specific antigen levels at diagnosis exceeded 10 ng/ml for 51% of enrollees, 50% had a Gleason score 7 or greater and 43% had clinical T stage T2 or greater. Of disadvantaged men 19% had metastatic cancer at diagnosis and this proportion remained stable over time (p = 0.66). Among men with nonmetastatic cancers 24% had tumors with low risk features and the proportion of low risk cancers did not increase over time (p = 0.34). CONCLUSIONS Unlike the broader United States population the proportion of disadvantaged men with organ confined, low risk prostate cancer has not been increasing. Thus, while much attention focuses on potential overdiagnosis and overtreatment of men with screen detected prostate cancer, our findings suggest that for low income, uninsured men, underdetection and undertreatment remain significant concerns.
Collapse
Affiliation(s)
- David C Miller
- Department of Urology, University of California, Los Angeles, California, USA.
| | | | | | | | | | | | | |
Collapse
|
45
|
Wagner SE, Burch JB, Hussey J, Temples T, Bolick-Aldrich S, Mosley-Broughton C, Liu Y, Hebert JR. Soil zinc content, groundwater usage, and prostate cancer incidence in South Carolina. Cancer Causes Control 2008; 20:345-53. [PMID: 18949566 DOI: 10.1007/s10552-008-9248-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 10/04/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prostate cancer (PrCA) incidence in South Carolina (SC) exceeds the national average, particularly among African Americans (AAs). Though data are limited, low environmental zinc exposures and down-regulation of prostatic zinc transporter proteins among AAs may explain, in part, the racial PrCA disparity. METHODS Age-adjusted PrCA rates were calculated by census tract. Demographic data were obtained from the 1990 census. Hazardous waste site locations and soil zinc concentrations were obtained from existing federal and state databases. A geographic information system and Poisson regression were used to test the hypothesis that census tracts with reduced soil zinc concentrations, elevated groundwater use, or more agricultural or hazardous waste sites had elevated PrCA risks. RESULTS Census tracts with high groundwater use and low zinc concentrations had higher PrCA rate ratios (RR: 1.270; 95% confidence interval: 1.079, 1.505). This effect was not more apparent in areas populated primarily by AAs. CONCLUSION Increased PrCA rates were associated with reduced soil zinc concentrations and elevated groundwater use, although this observation is not likely to contribute to SC's racial PrCA disparity. Statewide mapping and statistical modeling of relationships between environmental factors, demographics, and cancer incidence can be used to screen hypotheses focusing on novel PrCA risk factors.
Collapse
Affiliation(s)
- Sara E Wagner
- Cancer Prevention and Control Program, University of South Carolina, 2221 Devine Street, Columbia, SC 29208, USA.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Kinsey T, Jemal A, Liff J, Ward E, Thun M. Secular trends in mortality from common cancers in the United States by educational attainment, 1993-2001. J Natl Cancer Inst 2008; 100:1003-12. [PMID: 18612132 PMCID: PMC2467433 DOI: 10.1093/jnci/djn207] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Death rates for the four major cancer sites (lung, breast, prostate, and colon and rectum) have declined steadily in the United States among persons aged 25–64 years since the early 1990s. We used national data to examine these trends in relation to educational attainment. Methods We calculated age-standardized death rates for each of the four cancers by level of education among 25- to 64-year-old non-Hispanic white and non-Hispanic black men and women for 1993 through 2001 using data on approximately 86% of US deaths from the National Center for Health Statistics, education level as recorded on the death certificate, and population data from the US Bureau of Census Current Population Survey. Annual percent changes in age-adjusted death rates were estimated using weighted log-linear regression models. All statistical tests were two-sided. Results Death rates for each cancer decreased statistically significantly from 1993 to 2001 in people with at least 16 years of education in every sex and race stratum except lung cancer in black women, for whom death rates were stable. For example, colorectal cancer death rates among white men, black men, white women, and black women with at least 16 years of education decreased by 2.4% (P < .001), 4.8% (P = .011), 3.0% (P < .001), and 2.6% (P = .030) annually, respectively. By contrast, among people with less than 12 years of education, a statistically significant decrease in death rates from 1993 through 2001 was seen only for breast cancer in white women (1.4% per year; P = .029). Death rates among persons with less than 12 years of education over the same time interval increased for lung cancer in white women (2.4% per year; P < .001) and for colon cancer in black men (2.7% per year; P < .001) and were stable for the remaining race/sex/site strata. Temporal trends generally followed an educational gradient in which the slopes of the decreases in death rate became steeper with higher educational attainment. Conclusion The recent declines in death rates from major cancers in the United States mainly reflect declines in more highly educated individuals.
Collapse
Affiliation(s)
- Tracy Kinsey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | | | | |
Collapse
|
47
|
Lesbians and cancer: an overlooked health disparity. Cancer Causes Control 2008; 19:1009-20. [PMID: 18551371 DOI: 10.1007/s10552-008-9176-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 05/01/2008] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the breast, cervical, ovarian, lung, and colorectal cancer literatures using a novel application of the cancer disparities grid to identify disparities along domains of the cancer continuum focusing on lesbians as a minority population. METHODS Computerized databases were searched for articles published from 1981 to present. Cumulative search results identified 51 articles related to lesbians and disparities, which were classified by domain. RESULTS The majority of articles identified were related to breast and cervical cancer screening. Barriers to adequate screening for both cancers include personal factors, poor patient-provider communication, and health care system factors. Tailored risk counseling has been successful in increasing lesbian's mammography and Pap screening. Ovarian, lung, and colorectal cancer have been virtually unexplored in this population. An "Adjustment to Illness/Quality of Life" domain was added to capture literature on psychosocial aspects of cancer. CONCLUSIONS This review revealed a lack of research for specific cancers and for specific aspects of the cancer continuum. The limited number of studies identified focused on issues related to screening/prevention in cervical and breast cancers, with almost no attention to incidence, etiology, diagnosis, treatment, survival, morbidity, or mortality. We present implications for social and public health policy, research, and prevention.
Collapse
|
48
|
Abstract
Rehabilitation of cancer patients include a broad range of activities aimed at information, counselling, advices on possible change of lifestyle and behaviour, psychological support, social welfare questions, ways of coping with side-effects of the anti-carcinogenic treatment given and additional treatment of numerous clinical problems. The change in the age distribution combined with the growing number of cancer survivors and the scarce economic resources allocated to 'after-treatment' clinical follow-up of cancer patients, even in the Scandinavian countries characterised by their public tax financed health system, emphasize the need for screening of rehabilitation needs among cancer patients. There is a need to identify patients in need for psychological and social intervention. However, this intervention among cancer patients in need has to be based on results achieved in clinical studies. This paper gives a brief introduction to the field of rehabilitation research and indicates a number of areas in which research would be of benefit for the clinical organisation of rehabilitation activities. These areas include the implication of social inequality, a characterisation of cancer patients who rehabilitate successfully, the gender perspective in rehabilitation, the age perspective, how to establish cancer disease specific rehabilitation modules, family and community aspects of rehabilitation, the dilemma between individual responsibility for lifestyle changes and feelings of guilt and the need for models which can determine the best timing of the intervention among cancer patients.
Collapse
Affiliation(s)
- Christoffer Johansen
- Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
| |
Collapse
|
49
|
Gold HT, Do HT. Evaluation of three algorithms to identify incident breast cancer in Medicare claims data. Health Serv Res 2007; 42:2056-69. [PMID: 17850533 PMCID: PMC2254559 DOI: 10.1111/j.1475-6773.2007.00705.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To test the validity of three published algorithms designed to identify incident breast cancer cases using recent inpatient, outpatient, and physician insurance claims data. DATA The Surveillance, Epidemiology, and End Results (SEER) registry data linked with Medicare physician, hospital, and outpatient claims data for breast cancer cases diagnosed from 1995 to 1998 and a 5 percent control sample of Medicare beneficiaries in SEER areas. STUDY DESIGN We evaluate the sensitivity and specificity of three algorithms applied to new data compared with original reported results. Algorithms use health insurance diagnosis and procedure claims codes to classify breast cancer cases, with SEER as the reference standard. We compare algorithms by age, stage, race, and SEER region, and explore via logistic regression whether adding demographic variables improves algorithm performance. PRINCIPAL FINDINGS The sensitivity of two of three algorithms is significantly lower when applied to newer data, compared with sensitivity calculated during algorithm development (59 and 77.4 percent versus 90 and 80.2 percent, p<.00001). Sensitivity decreases as age increases, and false negative rates are higher for cases with in situ, metastatic, and unknown stage disease compared with localized or regional breast cancer. Substantial variation also exists by SEER registry. There was potential for improvement in algorithm performance when adding age, region, and race to an indicator variable for whether the algorithm determined a subject to be a breast cancer case (p<.00001). CONCLUSIONS Differential sensitivity of the algorithms by SEER region and age likely reflects variation in practice patterns, because the algorithms rely on administrative procedure codes. Depending on the algorithm, 3-5 percent of subjects overall are misclassified in 1998. Misclassification disproportionately affects older women and those diagnosed with in situ, metastatic, or unknown-stage disease. Algorithms should be applied cautiously to insurance claims databases to assess health care utilization outside SEER-Medicare populations because of uneven misclassification of subgroups that may be understudied already.
Collapse
Affiliation(s)
- Heather T Gold
- Department of Public Health, Weill Medical College of Cornell University, 411 E, 69th Street, New York, NY 10021, USA
| | | |
Collapse
|
50
|
Albano JD, Ward E, Jemal A, Anderson R, Cokkinides VE, Murray T, Henley J, Liff J, Thun MJ. Cancer mortality in the United States by education level and race. J Natl Cancer Inst 2007; 99:1384-94. [PMID: 17848670 DOI: 10.1093/jnci/djm127] [Citation(s) in RCA: 334] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although both race and socioeconomic status are well known to influence mortality patterns in the United States, few studies have examined the simultaneous influence of these factors on cancer incidence and mortality. We examined relationships among race, education level, and mortality from cancers of the lung, breast, prostate, colon and rectum, and all sites combined in contemporary US vital statistics. METHODS Age-adjusted cancer death rates (with 95% confidence intervals [CIs]) were calculated for 137,708 deaths among 119,376,196 individuals aged 25-64 years, using race and education information from death certificates and population denominator data from the US Bureau of the Census, for 47 states and Washington, DC, in 2001. Relative risk (RR) estimates were used to compare cancer death rates in persons with 12 or fewer years of education with those in persons with more than 12 years of education. RESULTS Educational attainment was strongly and inversely associated with mortality from all cancers combined in black and white men and in white women. The all-cancer death rates were nearly identical for black men and white men with 0-8 years of education (224.2 and 223.6 per 100,000, respectively). The estimated relative risk for all-cancer mortality comparing the three lowest (< or = 12 years) with the three highest (> 12 years) education categories was 2.38 (95% CI = 2.33 to 2.43) for black men, 2.24 (95% CI = 2.23 to 2.26) for white men, 1.43 (95% CI = 1.41 to 1.46) for black women, and 1.76 (95% CI = 1.75 to 1.78) for white women. For both men and women, the magnitude of the relative risks comparing the three lowest educational levels with the three highest within each race for all cancers combined and for lung and colorectal cancers was higher than the magnitude of the relative risks associated with race within each level of education, whereas for breast and prostate cancer the magnitude of the relative risks associated with race was higher than the magnitude of the relative risks associated with level of education within each racial group. Among the most important and novel findings were that black men who completed 12 or fewer years of education had a prostate cancer death rate that was more than double that of black men with more schooling (10.5 versus 4.8 per 100,000 men; RR = 2.17, 95% CI = 1.82 to 2.58) and that, in contrast with studies of mortality rates in earlier time periods, breast cancer mortality rates were higher among women with less education than among women with more education (37.0 and 31.1 per 100,000, respectively, for black women and 25.2 versus 18.6 per 100,000, respectively, for white women). CONCLUSION Cancer death rates vary considerably by level of education. Identifying groups at high risk of death from cancer by level of education as well as by race may be useful in targeting interventions and tracking cancer disparities.
Collapse
Affiliation(s)
- Jessica D Albano
- Epidemiology and Surveillance Research, American Cancer Society, 1599 Clifton Rd, Atlanta, GA 30329, USA
| | | | | | | | | | | | | | | | | |
Collapse
|