1
|
Vickers A, O'Brien F, Montorsi F, Galvin D, Bratt O, Carlsson S, Catto JW, Krilaviciute A, Philbin M, Albers P. Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit. BMJ 2023; 381:e071082. [PMID: 37197772 DOI: 10.1136/bmj-2022-071082] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Frank O'Brien
- Department of Urology, Cork University Hospital, Ireland
| | | | - David Galvin
- Department of Surgery, University College Dublin, Ireland
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Sigrid Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - James Wf Catto
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, UK
| | - Agne Krilaviciute
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Peter Albers
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany
| |
Collapse
|
2
|
Driedger SM, Kirby S, Maier R, Süss R, Thorlacius L, Saranchuk JW, Bohm E, Singer A. Strategies used in managing conversations about prostate-specific antigen (PSA) testing among family physicians (FPs): a qualitative study. BMJ Open 2023; 13:e073415. [PMID: 37117002 PMCID: PMC10151868 DOI: 10.1136/bmjopen-2023-073415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES Screening for prostate cancer in healthy asymptomatic men using the prostate-specific antigen (PSA) test is controversial due to conflicting recommendations from and a lack of strong evidence regarding the benefit of population-based screening. In Canada and internationally, there is variability in how family physicians (FPs) approach PSA testing in asymptomatic men. The purpose of our study was to explore how family FPs approach discussions with their male patients around PSA testing in Manitoba, Canada. DESIGN Qualitative descriptive study. SETTING AND PARTICIPANTS High-ordering and median-ordering FPs were invited to participate in an interview. In addition to exploring practice behaviours around PSA testing, participants were asked to elaborate on their typical discussion with asymptomatic men who request a PSA test or other tests and procedures that they do not feel are clinically warranted. Data were analysed inductively using a constant-comparison approach. RESULTS There were important variations between high-ordering and median-ordering FP's approaches to discussing PSA testing. Strategies to facilitate conversations were more frequently identified by median-ordering physicians and often included methods to facilitate assessing their patient's understanding and values. In addition to decision aids, median-ordering FPs used motivational interviewing to tailor a discussion, organised their practice structure and workflow habits in a way that enhanced patient-provider discussions and leveraged 'new' evidence and other aids to guide conversations with men. CONCLUSION We found that high-ordering FPs tended to use the PSA test for screening asymptomatic men with limited shared decision-making. Median-ordering FPs used conversational strategies that emphasised uncertainty of benefit and potential risk and did not present the test as a recommendation.
Collapse
Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah Kirby
- George & Fay Yee Centre for Healthcare Innovation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Maier
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roger Süss
- Department of Family Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laurel Thorlacius
- Department of Pathology, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Biochemistry and Medical Genetics, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeffery W Saranchuk
- Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada
| | - Eric Bohm
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alexander Singer
- Department of Family Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
3
|
Prostate-Specific Antigen Screening According to Health Professional Counseling and Age in the United States. Prostate Cancer 2022; 2022:8646314. [PMID: 35036010 PMCID: PMC8758274 DOI: 10.1155/2022/8646314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background In 2018, the US Preventive Services Task Force recommended that PSA screening for prostate cancer involve men aged 55–69, based on a personal decision following consultation with a health professional. PSA screening in men aged 70 or older should only occur if symptoms exist. This study identifies the association between having a PSA test in the past two years and whether or not there was consultation with a health professional about the benefits and/or harms of PSA screening. Methods Analyses were based on data involving men aged 40 years or older, who responded to PSA related questions in the 2018 BRFSS survey. Results Approximately 32.0% (14.6% for ages 40–54, 41.7% for ages 55–69, and 49.8% for ages 70 years and older) of respondents had a PSA test in the past two years. Approximately 81.7% of these men had talked with a health professional about the benefits and/or harms of PSA screening, with 42.4% having discussed the benefits and harms, 54.6% having discussed the benefits only, and 3.0% having discussed the harms only. The odds of a PSA test in the past two years in men having talked with a health professional about the benefits and harms of the test versus no talk are 10.1 (95% CI 9.3–10.8), in men who talked with a health professional about the benefits only versus no talk are 10.8 (95% CI 10.0–11.6), and in men who talked with a health professional about the harms only versus no talk are 3.9 (95% CI 2.9–5.1). Conclusion PSA screening is most common in men aged 70 or older, which is counter to the US Preventive Task Force recommendation. Most men having a PSA test have talked with a health professional about the test, but the talks tended to focus on just the benefits of screening and not both potential benefits and harms.
Collapse
|
4
|
Hajizadeh M, Whelan A, Johnston GM, Urquhart R. Socioeconomic Gradients in Prostate Cancer Incidence Among Canadian Males: A Trend Analysis From 1992 to 2010. Cancer Control 2021; 28:10732748211055272. [PMID: 34889129 PMCID: PMC8669872 DOI: 10.1177/10732748211055272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Understanding the effects of socioeconomic status on cancer incidence and their trends over time will help inform public health interventions for cancer control. This study sought to investigate trends in socioeconomic inequalities in prostate cancer incidence among Canadian males. Methods Using a census division level dataset (n = 280) constructed from the Canadian Cancer Registry, Canadian Census of Population (1992, 1996, 2001, 2006) and 2011 National Household Survey, we examined the effect of socioeconomic status on prostate cancer incidence among Canadian males between 1992 and 2010. The age-adjusted concentration index was used to quantify education/income-related inequalities in prostate cancer incidence. Results The crude prostate cancer incidence increased from 115 to 137 per 100 000 males in Canada from 1992 to 2010 with a peak in 2007. The rate increased significantly in all but three of four western provinces. The age-adjusted concentration index showed a higher concentration of prostate cancer diagnoses among males living in high-income neighbourhoods in Canada in particular from 1996 to 2005. In contrast, the index was higher among males living in less-educated neighbourhoods in the most recent study years (2006–2010). Conclusions The concentration of new prostate cancer cases among high-income populations in Canada may be explained by the rise of opportunistic screening of asymptomatic males; however, this should be studied in further detail. Since we found a higher incidence rate of prostate cancer among less-educated males in Canada in recent years, risk-benefit investigation of primary prevention and opportunistic screening for less-educated males is advised.
Collapse
Affiliation(s)
- Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, 3688Dalhousie University, Halifax, NS, Canada
| | - Ashley Whelan
- 12361Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Grace M Johnston
- Cancer Care Program, and School of Health Administration, 3688Dalhousie University, Halifax, NS, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Faculty of Medicine, 3688Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
5
|
Wang Q, Chen F, Jiang D, Kabani A, Sokoro AAH. Prostate-Specific Antigen Test Utilization in a Major Canadian City. Am J Clin Pathol 2020; 153:776-780. [PMID: 32003789 DOI: 10.1093/ajcp/aqaa003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To review the utilization of prostate-specific antigen (PSA) testing in Winnipeg, a major Canadian city, and to compare PSA testing rates between Winnipeg and Calgary, another major Canadian city of comparable size. METHODS PSA testing results were reviewed by year and age group. We focused our studies in years 2011 and 2016, for which census demographic data are available. RESULTS In Winnipeg, the PSA testing rates (patients with one or two PSA tests divided by the male population) showed a declining trend over years from 2008 to 2017. For almost all age groups, PSA testing rates in 2016 decreased in comparison to those in 2011. For age older than 40 years, the relative percentage decreases were 14% to 20%.In 2011, Winnipeg PSA testing rates were consistently higher than those in Calgary for all age groups. For age older than 40 years, the relative percentage differences were 36% to 50%.In addition, 41% and 40% of patients in Winnipeg who underwent PSA testing were younger than 50 years or older than 69 years in 2011 and 2016, respectively. CONCLUSIONS PSA testing utilization may be falling short of optimal rates. There is a need to reinforce the optimal use of clinical recommendations.
Collapse
Affiliation(s)
- Qunfeng Wang
- Diagnostic Services, Shared Health Manitoba, Winnipeg, Canada
| | - Fang Chen
- Departments of Finance and Accounting, I. H. Asper School of Business, University of Manitoba, Winnipeg, Canada
| | - Depeng Jiang
- Departments of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Amin Kabani
- Diagnostic Services, Shared Health Manitoba, Winnipeg, Canada
- Departments of Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - AbdulRazaq A H Sokoro
- Diagnostic Services, Shared Health Manitoba, Winnipeg, Canada
- Departments of Internal Medicine, University of Manitoba, Winnipeg, Canada
- Departments of Pathology, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
6
|
Ma I, Guo M, Pillai DR, Church DL, Naugler C. Is the Utilization of Helicobacter pylori Stool Antigen Tests Appropriate in an Urban Canadian Population? Am J Clin Pathol 2020; 153:686-694. [PMID: 32145011 PMCID: PMC7159178 DOI: 10.1093/ajcp/aqz210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Helicobacter pylori stool antigen test (HpSAT) appropriateness was investigated by assessing its testing and positivity rates in Calgary, Canada. METHODS The laboratory information system was accessed for all patients who received an HpSAT in 2018. Testing volume, test results, age, and sex of patients were collected. Sociodemographic risk factors and geospatial analysis were performed by matching laboratory data to the 2016 census data. Testing appropriateness was defined as a concordance between testing and positivity rates for each sociodemographic variable. RESULTS In 2018, 25,518 H pylori stool antigen tests were performed in Calgary, with an overall positivity rate of 14.7%. Geospatial mapping demonstrated significant distribution variations of testing and positivity rates of HpSAT in the city. Certain sociodemographic groups studied (eg, recent immigrants) appeared to be appropriately tested (testing rate relative risk [RR] = 2.26, positivity rate RR = 4.32; P < .0001), while other groups (eg, male) may have been undertested (testing rate RR = 0.85, positivity rate RR = 1.14; P < .0001). CONCLUSIONS Determining concordance of testing and positivity rate of a laboratory test can be used for assessing testing appropriateness for other diseases in other jurisdictions. This study demonstrated some at-risk patients may be missed for H pylori testing.
Collapse
Affiliation(s)
- Irene Ma
- Calgary Laboratory Services, Calgary, Canada
| | - Maggie Guo
- Calgary Laboratory Services, Calgary, Canada
| | - Dylan R Pillai
- Departments of Pathology and La Medicine
- Calgary Laboratory Services, Calgary, Canada
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Deirdre L Church
- Departments of Pathology and La Medicine
- Calgary Laboratory Services, Calgary, Canada
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Christopher Naugler
- Departments of Pathology and La Medicine
- Calgary Laboratory Services, Calgary, Canada
- Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
7
|
Tchir D, Farag M, Szafron M. Prostate-specific antigen (PSA) screening rates and factors associated with screening in Eastern Canadian men: Findings from cross-sectional survey data. Can Urol Assoc J 2020; 14:E319-E327. [PMID: 32017690 DOI: 10.5489/cuaj.6072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The prostate-specific antigen (PSA) test is used in Canada to detect prostate cancer (PCa) despite mixed recommendations. Complications arising from false-positives are common, posing as a cancer-screening concern. This work estimates some Canadian rates of PSA screening and identifies men at increased odds for PSA screening. METHODS The Canadian Community Health Survey (CCHS) from 2009/10 (Atlantic Canada; ATL), 2011/2012 (Ontario; ON), and 2013/2014 (Quebec; QC) were used. Lifetime and recent PSA screening with confidence intervals were constructed to estimate PSA screening in ATL, ON, and QC. Two logistic regression models (for men <50 and ≥50 years of age) were used to determine associations between factors and lifetime PSA screening. RESULTS PSA screening rates have increased in most age groups for ATL, ON, and QC since 2000/2001. Factors positively associated with lifetime PSA screening in men of all ages were: having a digital rectal exam, having a regular doctor, and having a colorectal exam. Fruit and vegetables consumption and non-smoking status were positively associated with lifetime PSA screening in men <50 years of age. High income and the presence of chronic health conditions were positively associated with lifetime PSA screening in men ≥50 years of age. CONCLUSIONS PSA screening rates have generally increased since 2000/2001 in Canada. Physician-related factors play a role in men at all ages, while different factors are associated in men <50 years of age and men ≥50 years of age. Limitations include the generalizability to all of Canada and the potential for recall bias.
Collapse
Affiliation(s)
- Devan Tchir
- University of Saskatchewan, School of Public Health, Saskatoon, SK, Canada
| | - Marwa Farag
- University of Saskatchewan, School of Public Health, Saskatoon, SK, Canada.,SPADE, Doha Institute for Graduate Studies, Doha, Qatar
| | - Michael Szafron
- University of Saskatchewan, School of Public Health, Saskatoon, SK, Canada
| |
Collapse
|
8
|
Peters CE, Villeneuve PJ, Parent MÉ. Occupation as a predictor of prostate cancer screening behaviour in Canada. J Med Screen 2020; 27:215-222. [PMID: 32000565 DOI: 10.1177/0969141320902485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES If prostate cancer screening practices relate to occupation, this would have important implications when studying the aetiological role of workplace exposures on prostate cancer. We identified variations in screening by occupation among men in Montreal, Canada (2005-2012). METHODS Prostate specific antigen testing and digital rectal examination (ever-screened and frequency of screening, previous five years) were examined among population controls from the Prostate Cancer & Environment Study. Face-to-face interviews elicited lifestyle and occupational histories. Multivariable logistic regression was used to estimate the odds of ever-screening for the longest-held occupation, adjusting for potential confounders. Negative binomial models were used to examine relationships with screening frequency. RESULTS Among 1989 controls, 81% reported ever having had a prostate specific antigen test, and 77% a digital rectal examination. Approximately 40% of men reported having a prostate specific antigen test once a year, on average. Compared with those in management or administrative jobs, men in primary industry (odds ratio 0.26, 95% confidence interval 0.10-0.65), construction (0.44, 0.25-0.79), machining (0.45, 0.21-0.97), and teaching (0.37, 0.20-0.70) were less likely to have undergone prostate specific antigen screening. Results were similar when considering the most recent job. CONCLUSIONS Our findings highlight substantial variations in prostate cancer screening by occupation. Men in occupations where carcinogen exposures are more common are less likely to participate in prostate screening activities. This could be an important source of bias, and occupational studies of prostate cancer should account for screening practices.
Collapse
Affiliation(s)
- Cheryl E Peters
- Department of Health Sciences, Carleton University, Ottawa, Canada.,Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, Université du Québec, Laval, Canada.,Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Paul J Villeneuve
- School of Mathematics and Statistics, Carleton University, Ottawa, Canada
| | - Marie-Élise Parent
- Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, Université du Québec, Laval, Canada
| |
Collapse
|
9
|
Lerhmann-Lerche CS, Larsen SB, Andersen I, Thygesen LC, Kaae Andersen K, Duun-Henriksen AK, Johansen C, Røder MA, Brasso K, Dalton SO. Educational level and first-time PSA testing in general practice. Scand J Urol 2019; 53:275-281. [PMID: 31663414 DOI: 10.1080/21681805.2019.1681503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Different patterns in the use of prostate-specific antigen (PSA) testing might explain socioeconomic differences in prostate cancer incidence and mortality. We examined the association between socioeconomic position, measured as education and first-time PSA testing in general practice.Material and Methods: A population-based cohort study of men aged 45-79 years without prior prostate cancer diagnosis living in the Capital Region of Denmark between 2000 and 2014. Information on socioeconomic indicators (education, income, cohabitation status and work market affiliation), prostate cancer diagnoses, and vital status were obtained from national registries. Date of first PSA test was obtained from the Copenhagen Primary Care Laboratory database. Temporal trends of PSA testing were calculated as annual age-standardised incidence rates and the association was examined by a multivariable Cox proportional hazards model.Results: The cohort consists of 431,997 men of which 105,476 (24%) had a first-time PSA test in the study period. Men with longer education, higher income, living with a partner, and employed had higher rates of PSA testing. For men with short education, the rate of PSA test was 28.3 tests per 1000 person-years compared to 31.2 tests among men with long education. The fully adjusted hazard ratio for a first PSA test among men with short education was 0.87 (95% CI, 0.85-0.89) compared to men with long education.Conclusion: The association between education and first-time PSA testing indicates socioeconomic disparities in health care utilisation, which could explain part of the observed socioeconomic difference in prostate cancer incidence and mortality.
Collapse
Affiliation(s)
- Caroline Sophie Lerhmann-Lerche
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Benzon Larsen
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Klaus Kaae Andersen
- Department of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne Katrine Duun-Henriksen
- Department of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Martin Andreas Røder
- Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus Brasso
- Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| |
Collapse
|
10
|
Dasgupta P, Baade PD, Aitken JF, Ralph N, Chambers SK, Dunn J. Geographical Variations in Prostate Cancer Outcomes: A Systematic Review of International Evidence. Front Oncol 2019; 9:238. [PMID: 31024842 PMCID: PMC6463763 DOI: 10.3389/fonc.2019.00238] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/18/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Previous reviews of geographical disparities in the prostate cancer continuum from diagnosis to mortality have identified a consistent pattern of poorer outcomes with increasing residential disadvantage and for rural residents. However, there are no contemporary, systematic reviews summarizing the latest available evidence. Our objective was to systematically review the published international evidence for geographical variations in prostate cancer indicators by residential rurality and disadvantage. Methods: Systematic searches of peer-reviewed articles in English published from 1/1/1998 to 30/06/2018 using PubMed, EMBASE, CINAHL, and Informit databases. Inclusion criteria were: population was adult prostate cancer patients; outcome measure was PSA testing, prostate cancer incidence, stage at diagnosis, access to and use of services, survival, and prostate cancer mortality with quantitative results by residential rurality and/or disadvantage. Studies were critically appraised using a modified Newcastle-Ottawa Scale. Results: Overall 169 studies met the inclusion criteria. Around 50% were assessed as high quality and 50% moderate. Men from disadvantaged areas had consistently lower prostate-specific antigen (PSA) testing and prostate cancer incidence, poorer survival, more advanced disease and a trend toward higher mortality. Although less consistent, predominant patterns by rurality were lower PSA testing, prostate cancer incidence and survival, but higher stage disease and mortality among rural men. Both geographical measures were associated with variations in access and use of prostate cancer-related services for low to high risk disease. Conclusions: This review found substantial evidence that prostate cancer indicators varied by residential location across diverse populations and geographies. While wide variations in study design limited comparisons across studies, our review indicated that internationally, men living in disadvantaged areas, and to a lesser extent more rural areas, face a greater prostate cancer burden. This review highlights the need for a better understanding of the complex social, environmental, and behavioral reasons for these variations, recognizing that, while important, geographical access is not the only issue. Implementing research strategies to help identify these processes and to better understand the central role of disadvantage to variations in health outcome are crucial to inform the development of evidence-based targeted interventions.
Collapse
Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Nicholas Ralph
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,St Vincent's Private Hospital, Toowoomba, QLD, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Suzanne Kathleen Chambers
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, WA, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Jeff Dunn
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia
| |
Collapse
|
11
|
Rat C, Schmeltz H, Rocher S, Nanin F, Gaultier A, Nguyen JM. Factors Related to Prostate-Specific Antigen-Based Prostate Cancer Screening in Primary Care: Retrospective Cohort Study of 120,587 French Men Over the Age of 50 Years. JMIR Public Health Surveill 2018; 4:e10352. [PMID: 30355559 PMCID: PMC6231884 DOI: 10.2196/10352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/29/2018] [Accepted: 07/17/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND International guidelines recommend avoiding prostate-specific antigen (PSA)-based prostate cancer screening in the elderly when life expectancy is less than 10 years. For younger men, most recommendations encourage a shared decision-making process taking into account patient comorbidities. OBJECTIVE The objective was to assess the performance of PSA-based prostate cancer screening in men older than 74 years and assess whether the presence (vs absence) of comorbidities was related to the performance of PSA testing in younger men aged 50 to 74 years who were eligible for screening. METHODS We analyzed data from the French national health care database (Loire-Atlantique geographic area). We reported the follow-up of two cohorts of men from April 1, 2014, to March 31, 2016: 22,480 men aged over 74 years and 98,107 men aged 50 to 74 years. We analyzed whether these patients underwent PSA testing after 2 years of follow-up and whether PSA testing performance was related to the following patient-related variables: age, low income, proxy measures indicative of major comorbidities (repeated ambulance transportation, having one of 30 chronic diseases, taking 5 or more drugs per day), or proxy measures indicative of specific comorbidities (cancer diseases, cardiovascular diseases, or psychiatric disorders). Statistical analysis was based on a multivariate mixed-effects logistic regression. RESULTS The proportion of patients who underwent a PSA-based screening test was 41.35% (9296/22,480) among men older than 74 years versus 41.05% (40,275/98,107) among men aged 50 to 74 years. The following factors were associated with less frequent PSA testing in men older than 74 years-age (odds ratio [OR] 0.89, 95% CI 0.88-0.89), low income (OR 0.18, 95% CI 0.05-0.69), suffering from a chronic disease (OR 0.82, 95% CI 0.76-0.88), repeated ambulance transportation (OR 0.37, 95% CI 0.31-0.44), diabetes requiring insulin (OR 0.51, 95% CI 0.43-0.60), dementia (OR 0.68, 95% CI 0.55-0.84), and antipsychotic treatment (OR 0.62, 95% CI 0.51-0.75)-whereas cardiovascular drug treatment was associated with more frequent PSA testing (OR 1.6, 95% CI 1.53-1.84). The following factors were associated with less frequent PSA testing in men aged 50 to 74 years-low income (OR 0.61, 95% CI 0.55-0.68); nonspecific conditions related to frailty: suffering from a chronic disease (OR 0.80, 95% CI 0.76-0.83), repeated ambulance transportation (OR 0.29, 95% CI 0.23-0.38), or chronic treatment with 5 or more drugs (OR 0.89, 95% CI 0.83-0.96); and various specific comorbidities: anticancer drug treatment (OR 0.67, 95% CI 0.55-0.83), diabetes requiring insulin (OR 0.55, 95% CI 0.49-0.61), and antiaggregant treatment (OR 0.91, 95% CI 0.86-0.96)-whereas older age (OR 1.07, 95% CI 1.07-1.08) and treatment with other cardiovascular drugs (OR 2.23, 95% CI 2.15-2.32) were associated with more frequent PSA testing. CONCLUSIONS In this study, 41.35% (9296/22,480) of French men older than 74 years had a PSA-based screening test. Although it depends on patient comorbidities, PSA testing remains inappropriate in certain populations.
Collapse
Affiliation(s)
- Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France.,Team 2, Unit 1232, French National Institute of Health and Medical Research, Nantes, France
| | - Heloise Schmeltz
- Team 2, Unit 1232, French National Institute of Health and Medical Research, Nantes, France
| | - Sylvain Rocher
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | | | - Aurélie Gaultier
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
| | - Jean-Michel Nguyen
- Team 2, Unit 1232, French National Institute of Health and Medical Research, Nantes, France.,Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
| |
Collapse
|
12
|
Ma I, Guo M, Muruve D, Benediktsson H, Naugler C. Sociodemographic associations with abnormal estimated glomerular filtration rate (eGFR) in a large Canadian city: a cross-sectional observation study. BMC Nephrol 2018; 19:198. [PMID: 30092764 PMCID: PMC6085713 DOI: 10.1186/s12882-018-0991-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/23/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is often asymptomatic in its early stages but is indicated and is diagnosed with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. Certain sociodemographic groups are known to be at risk for CKD, but it is unclear if there are strong associations between these at risk groups with abnormal eGFR test results in Canada. Using only secondary laboratory and Census data, geospatial variation and sociodemographic associations with abnormal eGFR result rate were investigated in Calgary, Alberta. METHODS Secondary laboratory data from all adult community patients who received an eGFR test result were collected from Calgary Laboratory Service's Laboratory Information System, which is the sole supplier of laboratory services for the large metropolitan city. Group-level sociodemographic variables were inferred by combining laboratory data with the 2011 Canadian Census data. Poisson regression and relative risk (RR) were used to calculate associations between sociodemographic variables with abnormal eGFR. Geographical distribution of abnormal eGFR result rates were analyzed by geospatial analysis using ArcGIS. RESULTS Of the 346,663 adult community patients who received an eGFR test result, 28,091 were abnormal (8.1%; eGFR < 60 ml/min/1.73m2). Geospatial analysis revealed distinct geographical variation in abnormal eGFR result rates in Calgary. Women (RR = 1.11, P < 0.0001), and the elderly (age ≥ 70 years; P < 0.0001) were significantly associated with an increased risk for CKD, while visible minority Chinese (RR = 0.73, P = 0.0011), South Asians (RR = 0.67, P < 0.0001) and those with a high median household income (RR = 0.88, P < 0.0001) had a significantly reduced risk for CKD. CONCLUSIONS Presented here are significant sociodemographic risk associations, and geospatial clustering of abnormal eGFR result rates in a large metropolitan Canadian city. Using solely publically available secondary laboratory and Census data, the results from this study aligns with known sociodemographic risk factors for CKD, as certain sociodemographic variables were at a higher risk for having an abnormal eGFR test result, while others were protective in this analysis.
Collapse
Affiliation(s)
- Irene Ma
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada
| | - Maggie Guo
- Calgary Laboratory Services, Calgary, AB, Canada
| | - Daniel Muruve
- Department of Medicine, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada
| | - Hallgrimur Benediktsson
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada
- Calgary Laboratory Services, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada.
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada.
- Calgary Laboratory Services, Calgary, AB, Canada.
| |
Collapse
|
13
|
Griener TP, Naugler C, Chan WW, Church DL. Sociodemographic correlates of urine culture test utilization in Calgary, Alberta. BMC Urol 2018; 18:2. [PMID: 29310636 PMCID: PMC5759274 DOI: 10.1186/s12894-018-0315-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/01/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Many clinical practice guidelines encourage diagnosis and empiric treatment of lower urinary tract infection without laboratory investigation; however, urine culture testing remains one of the largest volume tests in the clinical microbiology laboratory. In this study, we sought to determine if there were specific patient groups to which increased testing was directed. To do so, we combined laboratory data on testing rates with Census Canada sociodemographic data. METHODS Urine culture testing data was obtained from the Calgary Laboratory Services information system for 2011. We examined all census dissemination areas within the city of Calgary and, for each area, testing rates were determined for age and gender cohorts. We then compared these testing rates to sociodemographic factors obtained from Census Canada and used Poisson regression and generalized estimating equations to test associations between testing rates and sociodemographic variables. RESULTS Per capita urine culture testing is increasing in Calgary. For 2011, 100,901 individuals (9.2% of all people) received urine cultures and were included in this analysis. The majority of cultures were received from the community (67.9%). Substantial differences in rate of testing were observed across the city. Most notably, urine culture testing was drastically lower in areas of high (≥ $100000) household income (RR = 0.07, p < 0.0001) and higher employment rate (RR = 0.36, p < 0.0001). Aboriginal - First Nations status (RR = 0.29, p = 0.0008) and Chinese visible minority (RR = 0.67, p = 0.0005) were also associated with decreased testing. Recent immigration and visible minority status of South Asian, Filipino or Black were not significant predictors of urine culture testing. Females were more likely to be tested than males (RR = 2.58, p < 0.0001) and individuals aged 15-39 were the most likely to be tested (RR = 1.69, p < 0.0001). CONCLUSIONS Considerable differences exist in urine culture testing across Calgary and these are associated with a number of sociodemographic factors. In particular, areas of lower socioeconomic standing had significantly increased rates of testing. These observations highlight specific groups that should be targeted to improve healthcare delivery and, in turn, enhance laboratory utilization.
Collapse
Affiliation(s)
- Thomas P Griener
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Division of Microbiology, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Wilson W Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Division of Microbiology, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Deirdre L Church
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada. .,Division of Microbiology, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Medicine, University of Calgary, Calgary, AB, Canada. .,1W-410, Diagnostic and Scientific Centre, 9-3535 Research Road NW, Calgary, AB, T2L 2K8, Canada.
| |
Collapse
|
14
|
Barber J, Guo M, Nguyen LT, Thomas R, Turin TC, Vaska M, Naugler C. Sociodemographic Correlates of Clinical Laboratory Test Expenditures in a Major Canadian City. Am J Clin Pathol 2017; 148:91-96. [PMID: 28605433 DOI: 10.1093/ajcp/aqx052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The increasing cost of clinical laboratory testing is a challenge in our health care system. This study aims to calculate the annual clinical laboratory test costs attributed to patients in a major Canadian city and to correlate them to their sociodemographic variables. METHODS Retrospective cohort study involving patients who received clinical chemistry, hematology, and microbiology tests in 2011 in Calgary, Canada (n = 610,409). Test volumes were obtained from a laboratory informatics database. Total expenditures per patient were calculated using estimated test costs and then combined with the 2011 Canadian Census Household Survey results to infer sociodemographic correlates. RESULTS While more women received laboratory testing (58.4%), men had slightly higher testing costs per capita. Except for Chinese, visible minority and Aboriginal populations had higher testing costs. There was an inverse correlation between testing cost and household income, and accordingly, higher costs were found in those without postsecondary education and the unemployed. Furthermore, hotspot mapping revealed the geographical distribution of patient test costs within the city. CONCLUSIONS There is variation in testing costs for patients among different sociodemographic variables.
Collapse
Affiliation(s)
- Jocelyn Barber
- From the Department of Pathology, College of Medicine, University of Saskatchewan, Saskatoon,Canada
| | - Maggie Guo
- Alberta Health Services Utilization Office, Calgary Laboratory Services, Calgary,Canada
| | | | - Roger Thomas
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary,Canada; and
| | - Tanvir Chowdhury Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary,Canada; and
| | - Marcus Vaska
- Knowledge Resource Service, Alberta Health Services, Calgary,Canada
| | - Christopher Naugler
- Alberta Health Services Utilization Office, Calgary Laboratory Services, Calgary,Canada
- Department of Pathology & Laboratory Medicine and
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary,Canada; and
| | | |
Collapse
|
15
|
Freedland SJ, Vidal AC, Howard LE, Terris MK, Cooperberg MR, Amling CL, Kane CJ, Aronson WJ. Race and risk of metastases and survival after radical prostatectomy: Results from the SEARCH database. Cancer 2017; 123:4199-4206. [PMID: 28654204 DOI: 10.1002/cncr.30834] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/25/2017] [Accepted: 05/18/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Black race is associated with prostate cancer (PC) diagnosis and poor outcome. Previously, the authors reported that black men undergoing radical prostatectomy (RP) in equal-access hospitals had an increased risk of biochemical disease recurrence (BCR), but recurrences were equally aggressive as those occurring in white men. The authors examined the association between race and long-term outcomes after RP. METHODS Data regarding 1665 black men (37%) and 2791 white men (63%) undergoing RP were analyzed. Using Cox models, the authors tested the association between race and BCR, BCR with a prostate-specific antigen (PSA) doubling time <9 months (aggressive disease recurrence), metastases, PC-specific death, and overall death. RESULTS At a median follow-up of 102 months, 1566 men (35%) developed BCR, 217 men (5%) experienced aggressive disease recurrence, 193 men (4%) developed metastases, and 1207 men (27%) had died, 107 of whom (2%) died of PC. White men were older and had a lower preoperative PSA level, a lower biopsy and pathological grade group, and more capsular penetration but less seminal vesicle invasion and positive surgical margins versus black men (all P<.05). Black men were found to have a more recent surgery year (P<.001). On univariable analysis, black race was associated with increased BCR (P = .003) and reduced overall death (P = .017). On multivariable analysis, black race was not found to be associated with BCR (hazard ratio [HR], 1.07; P = .26), aggressive recurrence (HR, 1.14; P = .42), metastasis (HR, 1.24; P = .21), PC-specific death (HR, 1.03; P = .91), or overall death (HR, 1.03; P = .67). CONCLUSIONS Among men undergoing RP at equal-access centers, although black men were found to have an increased risk of BCR, they had similar risks of aggressive disease recurrence, metastasis, and PC-specific death compared with white men, and the risk of BCR was found to be similar after controlling for risk parameters. Longer follow-up is needed to confirm these findings. Cancer 2017;123:4199-4206. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Stephen J Freedland
- Urology Section, Veterans Affairs Medical Center, Durham, North Carolina.,Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Adriana C Vidal
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lauren E Howard
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Martha K Terris
- Urology Section, Veterans Affairs Medical Center, Augusta, Georgia.,Section of Urology, Department of Surgery, Medical College of Georgia, Augusta, Georgia
| | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco, California.,University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | | | - Christopher J Kane
- Division of Urology, University of California at San Diego School of Medicine, San Diego, California
| | - William J Aronson
- Urology Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Urology, University of California at Los Angeles School of Medicine, Los Angeles, California
| | | |
Collapse
|
16
|
Nderitu P, Van Hemelrijck M, Ashworth M, Mathur R, Hull S, Dudek A, Chowdhury S. Prostate-specific antigen testing in inner London general practices: are those at higher risk most likely to get tested? BMJ Open 2016; 6:e011356. [PMID: 27406644 PMCID: PMC4947776 DOI: 10.1136/bmjopen-2016-011356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/02/2016] [Accepted: 06/06/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To investigate the association between factors influencing prostate-specific antigen (PSA) testing prevalence including prostate cancer risk factors (age, ethnicity, obesity) and non-risk factors (social deprivation and comorbidity). SETTING A cross-sectional database of 136 inner London general practices from 1 August 2009 to 31 July 2014. PARTICIPANTS Men aged ≥40 years without prostate cancer were included (n=150 481). PRIMARY OUTCOME Logistic regression analyses were used to estimate the association between PSA testing and age, ethnicity, social deprivation, body mass index (BMI) and comorbidity while adjusting for age, benign prostatic hypertrophy, prostatitis and tamsulosin or finasteride use. RESULTS PSA testing prevalence was 8.2% (2013-2014), and the mean age was 54 years (SD 11). PSA testing was positively associated with age (OR 70-74 years compared to 40-44 years: 7.34 (95% CI 6.82 to 7.90)), ethnicity (black) (OR compared to white: 1.78 (95% CI 1.71 to 1.85)), increasing BMI and cardiovascular comorbidity. Testing was negatively associated with Chinese ethnicity and with increasing social deprivation. CONCLUSIONS PSA testing among black patients was higher compared to that among white patients, which differs from lower testing rates seen in previous studies. PSA testing was positively associated with prostate cancer risk factors and non-risk factors. Association with non-risk factors may increase the risk of unnecessary invasive diagnostic procedures.
Collapse
Affiliation(s)
- Paul Nderitu
- Department of Oncology, Guy's Hospital, London, UK
| | - Mieke Van Hemelrijck
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Rohini Mathur
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sally Hull
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | | |
Collapse
|
17
|
Nordström T, Bratt O, Örtegren J, Aly M, Adolfsson J, Grönberg H. A population-based study on the association between educational length, prostate-specific antigen testing and use of prostate biopsies. Scand J Urol 2015; 50:104-9. [PMID: 26625178 DOI: 10.3109/21681805.2015.1113200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether educational length affects prostate-specific antigen (PSA) testing and the time to prostate biopsy for men with raised PSA values. MATERIALS AND METHODS Using register data on all men in Stockholm County in 2013 (n = 1,052,841), the limited-duration point prevalence of PSA testing and time between test and prostate biopsy or repeat testing were analysed. Patterns of follow-up were assessed using Kaplan-Meier product limit estimators and Cox proportional hazard models. Educational length was categorized as short (≤ 9 years), intermediate (10-12 years) or long (≥ 13 years). RESULTS PSA testing increased with educational length in all age groups. Among men aged 50-69 years, 61% with long and 54% with short education had had a PSA test within the preceding 10 years (p < 0.001). In men with PSA 4-10 ng/ml, 40% [95% confidence interval (CI) 38-41] with long and 27% (95% CI 26-29) with short education underwent a prostate biopsy within 12 months. After adjusting for PSA level and age, educational length was still associated with the chance of having a prostate biopsy in men with PSA 4-10 ng/ml (hazard ratio 1.22, 95% CI 1.12-1.31), but not in men with higher PSA values. CONCLUSION PSA testing increased with educational length. Men with long education were more likely to have a prostate biopsy after an increased PSA value below 10 ng/ml than men with short education. These differences may contribute to the worse prostate cancer outcomes observed among men with lower socioeconomic status.
Collapse
Affiliation(s)
- Tobias Nordström
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden ;,b Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden ;,c Department of Urology , Helen Diller Family Comprehensive Cancer Center, University of California , San Francisco , CA , USA
| | - Ola Bratt
- d Urological Cancer Research Unit, Department of Translational Medicine , Lund University , Lund , Sweden ;,e Department of Urology , Cambridge University Hospitals , Cambridge , UK
| | - Joakim Örtegren
- d Urological Cancer Research Unit, Department of Translational Medicine , Lund University , Lund , Sweden
| | - Markus Aly
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden
| | - Jan Adolfsson
- f Karolinska Institutet , Department of Clinical Science, Intervention and Technology (CLINTEC) , Stockholm , Sweden ;,g Swedish Council for Health Technology Assessment , Stockholm , Sweden
| | - Henrik Grönberg
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden
| |
Collapse
|
18
|
Baskin L, Abdullah A, Guo M, Naugler C. Use of geospatial mapping to determine suitable locations for patient service centers for phlebotomy services. Am J Clin Pathol 2015; 144:727-30. [PMID: 26486736 DOI: 10.1309/ajcp4j1xkdvjiugs] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Approaches to determining optimal locations for patient service centers (phlebotomy clinics) have not been addressed in the published literature. Using the city of Calgary, Alberta, Canada, as a test case, our objective is to present a novel method for determining underserviced geographic areas within a city to guide the choice of potential new patient service center locations. METHODS Data on travel distances for 198,883 phlebotomy visits as well as population data from the 2011 Canada Census were used for this study. Using geospatial mapping techniques, we produced maps of the city showing actual relative travel distances for patients as well as the geographic distribution of population density of patients undergoing phlebotomies. RESULTS There was a striking pattern of increased travel distances in certain parts of the city. These also corresponded to geographic areas with greater density of patients seeking phlebotomies. CONCLUSIONS This analysis provided clear, objective evidence of communities that are currently relatively underserved by patient service centers. This approach could be used by other laboratories to plan the location of new patient service centers.
Collapse
|
19
|
Naugler C, Thomas R, Turin TC, Guo M. Yearly Clinical Laboratory Test Expenditures for Different Medical Specialties in a Major Canadian City. Am J Clin Pathol 2015; 144:97-102. [PMID: 26071467 DOI: 10.1309/ajcp80repiugvxph] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Very little is known about the relative contributions of physician specialty groups and individual physicians to overall clinical laboratory expenditures. The objectives of this study were to determine the costs of clinical laboratory test expenditures attributable to 30 medical specialties and the associated per capita physician expenditures for an entire major Canadian city. Only chemistry, hematology, and microbiology tests were included in this study. METHODS Retrospective cohort study involving all physicians in Calgary, Canada, and surrounding areas (n = 3,499) and secondary data on laboratory test orders. RESULTS Data were obtained on approximately 20 million test requests. The mean clinical laboratory test expenditure, in Canadian dollars, per physician was $27,945 for all physicians combined. Total expenditures by primary care physicians (family physicians and general practitioners) accounted for 58% of total expenditures. CONCLUSIONS There was wide variation in clinical laboratory test expenditures among specialties and on a per capita basis within medical specialties.
Collapse
|
20
|
Feletto E, Bang A, Cole-Clark D, Chalasani V, Rasiah K, Smith DP. An examination of prostate cancer trends in Australia, England, Canada and USA: Is the Australian death rate too high? World J Urol 2015; 33:1677-87. [PMID: 25698456 PMCID: PMC4617845 DOI: 10.1007/s00345-015-1514-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/23/2015] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare prostate cancer incidence and mortality rates in Australia, USA, Canada and England and quantify the gap between observed prostate cancer deaths in Australia and expected deaths, using US mortality rates. METHODS Analysis of age-standardised prostate cancer incidence and mortality rates, using routinely available data, in four similarly developed countries and joinpoint regression to quantify the changing rates (annual percentage change: APC) and test statistical significance. Expected prostate cancer deaths, using US mortality rates, were calculated and compared with observed deaths in Australia (1994-2010). RESULTS In all four countries, incidence rates initially peaked between 1992 and 1994, but a second, higher peak occurred in Australia in 2009 (188.9/100,000), rising at a rate of 5.8 % (1998-2008). Mortality rates in the USA (APC: -2.9 %; 2004-2010), Canada (APC: -2.9 %; 2006-2011) and England (APC: -2.6 %; 2003-2008) decreased at a faster rate compared with Australia (APC: -1.7 %; 1997-2011). In 2010, mortality rates were highest in England and Australia (23.8/100,000 in both countries). The mortality gap between Australia and USA grew from 1994 to 2010, with a total of 10,895 excess prostate cancer deaths in Australia compared with US rates over 17 preceding years. CONCLUSIONS Prostate cancer incidence rates are likely heavily influenced by prostate-specific antigen testing, but the fall in mortality occurred too soon to be solely a result of testing. Greater emphasis should be placed on addressing system-wide differences in the management of prostate cancer to reduce the number of men dying from this disease.
Collapse
Affiliation(s)
- E Feletto
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.
| | - A Bang
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.
| | - D Cole-Clark
- Department of Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.
| | - V Chalasani
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Discipline of Surgery, University of Sydney, Camperdown, NSW, Australia. .,Northern Sydney Local Health District, St Leonards, NSW, Australia.
| | - K Rasiah
- Northern Sydney Local Health District, St Leonards, NSW, Australia. .,Kinghorn Cancer Centre, Garvan Institute of Medical Research, St Leonards, NSW, Australia.
| | - D P Smith
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia. .,Griffith Health Institute, Griffith University, Nathan, QLD, Australia.
| |
Collapse
|