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Iyer HS, Stone BV, Roscoe C, Hsieh MC, Stroup AM, Wiggins CL, Schumacher FR, Gomez SL, Rebbeck TR, Trinh QD. Access to Prostate-Specific Antigen Testing and Mortality Among Men With Prostate Cancer. JAMA Netw Open 2024; 7:e2414582. [PMID: 38833252 DOI: 10.1001/jamanetworkopen.2024.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
Importance Prostate-specific antigen (PSA) screening for prostate cancer is controversial but may be associated with benefit for certain high-risk groups. Objectives To evaluate associations of county-level PSA screening prevalence with prostate cancer outcomes, as well as variation by sociodemographic and clinical factors. Design, Setting, and Participants This cohort study used data from cancer registries based in 8 US states on Hispanic, non-Hispanic Black, and non-Hispanic White men aged 40 to 99 years who received a diagnosis of prostate cancer between January 1, 2000, and December 31, 2015. Participants were followed up until death or censored after 10 years or December 31, 2018, whichever end point came first. Data were analyzed between September 2023 and January 2024. Exposure County-level PSA screening prevalence was estimated using the Behavior Risk Factor Surveillance System survey data from 2004, 2006, 2008, 2010, and 2012 and weighted by population characteristics. Main Outcomes and Measures Multivariable logistic, Cox proportional hazards regression, and competing risks models were fit to estimate adjusted odds ratios (AOR) and adjusted hazard ratios (AHR) for associations of county-level PSA screening prevalence at diagnosis with advanced stage (regional or distant), as well as all-cause and prostate cancer-specific survival. Results Of 814 987 men with prostate cancer, the mean (SD) age was 67.3 (9.8) years, 7.8% were Hispanic, 12.2% were non-Hispanic Black, and 80.0% were non-Hispanic White; 17.0% had advanced disease. There were 247 570 deaths over 5 716 703 person-years of follow-up. Men in the highest compared with lowest quintile of county-level PSA screening prevalence at diagnosis had lower odds of advanced vs localized stage (AOR, 0.86; 95% CI, 0.85-0.88), lower all-cause mortality (AHR, 0.86; 95% CI, 0.85-0.87), and lower prostate cancer-specific mortality (AHR, 0.83; 95% CI, 0.81-0.85). Inverse associations between PSA screening prevalence and advanced cancer were strongest among men of Hispanic ethnicity vs other ethnicities (AOR, 0.82; 95% CI, 0.78-0.87), older vs younger men (aged ≥70 years: AOR, 0.77; 95% CI, 0.75-0.79), and those in the Northeast vs other US Census regions (AOR, 0.81; 95% CI, 0.79-0.84). Inverse associations with all-cause mortality were strongest among men of Hispanic ethnicity vs other ethnicities (AHR, 0.82; 95% CI, 0.78-0.85), younger vs older men (AHR, 0.81; 95% CI, 0.77-0.85), those with advanced vs localized disease (AHR, 0.80; 95% CI, 0.78-0.82), and those in the West vs other US Census regions (AHR, 0.89; 95% CI, 0.87-0.90). Conclusions and Relevance This population-based cohort study of men with prostate cancer suggests that higher county-level prevalence of PSA screening was associated with lower odds of advanced disease, all-cause mortality, and prostate cancer-specific mortality. Associations varied by age, race and ethnicity, and US Census region.
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Affiliation(s)
- Hari S Iyer
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Benjamin V Stone
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Urology, Massachusetts General Hospital, Boston
| | - Charlotte Roscoe
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health at Louisiana State University Health Sciences Center, New Orleans
| | - Antoinette M Stroup
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
- New Jersey State Cancer Registry, Trenton
| | - Charles L Wiggins
- New Mexico Tumor Registry, University of New Mexico Comprehensive Cancer Center, Albuquerque
| | - Fredrick R Schumacher
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Population and Cancer Prevention Program, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Timothy R Rebbeck
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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2
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Zheng Y, Mao J, Yang L, Zhu Q. Recent trends in the incidence of early-onset prostate cancer. Eur J Cancer Prev 2024:00008469-990000000-00150. [PMID: 38837196 DOI: 10.1097/cej.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Early-onset prostate cancer (EOPC) is relatively uncommon. It is unclear if the incidence of EOPC is evolving. Utilizing data from the SEER database from 2000 to 2020, the study identified prostate cancer cases in men under 55 years, focusing on trends in annual age-adjusted incidence rates (AAIR), stage at presentation, race/ethnicity, and local treatment patterns. The study encompassed 93 071 cases of EOPC, with the median age at diagnosis being 51 years. From 2000 to 2007, the AAIR of EOPC experienced a wave-like increase from 6.9 to 8.3 per 100 000 people. It then sharply declined to 5.4 by 2014, followed by 6 years of stability, and by 2020 it had dropped to its lowest point of 4.5. The trend observed across different racial groups was consistent with the overall pattern, where non-Hispanic Black patients consistently exhibited the highest incidence and the least reduction rate (annual percent change, -1.0; 95% confidence interval, -1.8 to -0.2; P < 0.05). Stage II was the most commonly diagnosed, although its AAIR declined from 4.9 to 1.2 per 100 000 people. From 2010 through 2020, the proportion of receiving prostatectomy decreased from 63.0 to 43.6%. The declining rates of EOPC across diverse racial groups emphasize the critical need for focused research and interventions. Specifically, there is an urgent call to establish a tailored screening protocol for prostate cancer targeting Black youth.
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Affiliation(s)
- Yanjun Zheng
- Department of Urology, Quzhou Hospital of Traditional Chinese Medicine, Quzhou
| | - Jinshui Mao
- Department of Urology, Quzhou Hospital of Traditional Chinese Medicine, Quzhou
| | - Lina Yang
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao
| | - Qiansan Zhu
- Department of Urology, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
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3
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Garraway IP, Carlsson SV, Nyame YA, Vassy JL, Chilov M, Fleming M, Frencher SK, George DJ, Kibel AS, King SA, Kittles R, Mahal BA, Pettaway CA, Rebbeck T, Rose B, Vince R, Winn RA, Yamoah K, Oh WK. Prostate Cancer Foundation Screening Guidelines for Black Men in the United States. NEJM EVIDENCE 2024; 3:EVIDoa2300289. [PMID: 38815168 DOI: 10.1056/evidoa2300289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States. METHODS A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis. CONCLUSIONS These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.).
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Affiliation(s)
- Isla P Garraway
- Department of Urology, David Geffen School of Medicine, University of California and Department of Surgical and Perioperative Care, VA Greater Los Angeles Healthcare System, Los Angeles
| | - Sigrid V Carlsson
- Departments of Surgery and Epidemiology and Biostatistics, Urology Service, Memorial Sloan Kettering Cancer Center, New York
- Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, and Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden
| | - Yaw A Nyame
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle
- Department of Urology, University of Washington, Seattle
| | - Jason L Vassy
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Health Administration, Bedford and Boston
- Harvard Medical School and Brigham and Women's Hospital, Boston
| | - Marina Chilov
- Medical Library, Memorial Sloan Kettering Cancer Center, New York
| | - Mark Fleming
- Virginia Oncology Associates, US Oncology Network, Norfolk, VA
| | - Stanley K Frencher
- Martin Luther King Jr. Community Hospital and University of California, Los Angeles
| | - Daniel J George
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | - Adam S Kibel
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Sherita A King
- Section of Urology, Medical College of Georgia at Augusta University and Charlie Norwood Veterans Affairs Medical Center, Augusta, GA
| | - Rick Kittles
- Morehouse School of Medicine, Community Health and Preventive Medicine, Atlanta
| | - Brandon A Mahal
- Sylvester Comprehensive Cancer Center, Miami
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston
| | - Timothy Rebbeck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
- Harvard T.H. Chan School of Public Health, Boston
| | - Brent Rose
- Department of Radiation Oncology, University of California, San Diego
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Randy Vince
- Department of Urology, University of Michigan, Ann Arbor
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond
- Department of Internal Medicine, Virginia Commonwealth University, Richmond
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
- James A. Haley Veterans' Hospital, Tampa, FL
| | - William K Oh
- Prostate Cancer Foundation, Santa Monica, CA
- Division of Hematology and Medical Oncology, Tisch Cancer Institute at Mount Sinai, New York
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4
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Ramakrishnan S, Cortes-Gomez E, Athans SR, Attwood KM, Rosario SR, Kim SJ, Mager DE, Isenhart EG, Hu Q, Wang J, Woloszynska A. Race-specific coregulatory and transcriptomic profiles associated with DNA methylation and androgen receptor in prostate cancer. Genome Med 2024; 16:52. [PMID: 38566104 PMCID: PMC10988846 DOI: 10.1186/s13073-024-01323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Prostate cancer is a significant health concern, particularly among African American (AA) men who exhibit higher incidence and mortality compared to European American (EA) men. Understanding the molecular mechanisms underlying these disparities is imperative for enhancing clinical management and achieving better outcomes. METHODS Employing a multi-omics approach, we analyzed prostate cancer in both AA and EA men. Using Illumina methylation arrays and RNA sequencing, we investigated DNA methylation and gene expression in tumor and non-tumor prostate tissues. Additionally, Boolean analysis was utilized to unravel complex networks contributing to racial disparities in prostate cancer. RESULTS When comparing tumor and adjacent non-tumor prostate tissues, we found that DNA hypermethylated regions are enriched for PRC2/H3K27me3 pathways and EZH2/SUZ12 cofactors. Olfactory/ribosomal pathways and distinct cofactors, including CTCF and KMT2A, were enriched in DNA hypomethylated regions in prostate tumors from AA men. We identified race-specific inverse associations of DNA methylation with expression of several androgen receptor (AR) associated genes, including the GATA family of transcription factors and TRIM63. This suggests that race-specific dysregulation of the AR signaling pathway exists in prostate cancer. To investigate the effect of AR inhibition on race-specific gene expression changes, we generated in-silico patient-specific prostate cancer Boolean networks. Our simulations revealed prolonged AR inhibition causes significant dysregulation of TGF-β, IDH1, and cell cycle pathways specifically in AA prostate cancer. We further quantified global gene expression changes, which revealed differential expression of genes related to microtubules, immune function, and TMPRSS2-fusion pathways, specifically in prostate tumors of AA men. Enrichment of these pathways significantly correlated with an altered risk of disease progression in a race-specific manner. CONCLUSIONS Our study reveals unique signaling networks underlying prostate cancer biology in AA and EA men, offering potential insights for clinical management strategies tailored to specific racial groups. Targeting AR and associated pathways could be particularly beneficial in addressing the disparities observed in prostate cancer outcomes in the context of AA and EA men. Further investigation into these identified pathways may lead to the development of personalized therapeutic approaches to improve outcomes for prostate cancer patients across different racial backgrounds.
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Affiliation(s)
- Swathi Ramakrishnan
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Eduardo Cortes-Gomez
- Department of Bioinformatics and Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
- Department of Biostatistics, SUNY University at Buffalo, Kimball Tower, Buffalo, NY, 14214, USA
| | - Sarah R Athans
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Kristopher M Attwood
- Department of Bioinformatics and Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Spencer R Rosario
- Department of Bioinformatics and Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Se Jin Kim
- Department of Pharmaceutical Sciences, SUNY University at Buffalo, Buffalo, NY, 14214, USA
| | - Donald E Mager
- Department of Pharmaceutical Sciences, SUNY University at Buffalo, Buffalo, NY, 14214, USA
- Enhanced Pharmacodynamics, LLC, Buffalo, NY, 14203, USA
| | - Emily G Isenhart
- Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Qiang Hu
- Department of Bioinformatics and Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Jianmin Wang
- Department of Bioinformatics and Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Anna Woloszynska
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
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5
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Morley F, Iyer HS, Tamimi RM, Nanus DM, Rebbeck TR, Kensler KH. Prostate-specific antigen testing rates in high-risk populations: results from the All of Us Research Program. Cancer Causes Control 2024; 35:509-521. [PMID: 37878135 PMCID: PMC10838840 DOI: 10.1007/s10552-023-01807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Early detection of prostate cancer using prostate-specific antigen (PSA) remains controversial and disparities in the receipt of prostate cancer screening persist in the US. We sought to examine disparities in PSA testing rates among groups with higher prostate cancer risk and differential access to healthcare. METHODS We identified a cohort of 37,706 males within the All of Us Research Program without a history of prostate cancer between the ages of 40 and 85 at time of enrollment (2017-2021). Incidence rate ratios (IRR) for the number of PSA tests received during follow-up through December 2021 were estimated using age- and multivariable-adjusted negative binomial regression models. PSA testing frequencies in the cohort were compared with population-based estimates from the 2020 Behavioral Risk Factor Surveillance System (BRFSS). RESULTS A total of 6,486 males (17.2%) received at least one PSA test over the course of follow-up. In multivariable-adjusted models, non-Hispanic Black males received PSA tests at a 17% lower rate (IRR = 0.83, 95% CI 0.76, 0.90) than non-Hispanic White males. Higher educational attainment, higher annual income, having self-/employer-purchased insurance, having a spouse or domestic partner, and having a family history of prostate cancer were all associated with higher rates of PSA testing. The proportion of males ages 55 to 69 who received a PSA test within two years was lower in All of Us (12.4%, 95% CI 11.8-13.0%) relative to population-based estimates from the BRFSS (35.2%, 95% CI 34.2-36.3%). CONCLUSION Absolute PSA testing rates in All of Us were lower than population-based estimates, but associations with PSA testing in the cohort mirrored previously reported disparities in prostate cancer screening. These findings highlight the importance of addressing barriers to care in order to reduce disparities in cancer screening.
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Affiliation(s)
- Faith Morley
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67th Street LA-265, New York, NY, 10065, USA
| | - Hari S Iyer
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67th Street LA-265, New York, NY, 10065, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - David M Nanus
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Division of Hematology and Oncology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Timothy R Rebbeck
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kevin H Kensler
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67th Street LA-265, New York, NY, 10065, USA.
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
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6
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Amini AE, Salari K. Incorporating Genetic Risk Into Prostate Cancer Care: Implications for Early Detection and Precision Oncology. JCO Precis Oncol 2024; 8:e2300560. [PMID: 38412389 DOI: 10.1200/po.23.00560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 02/29/2024] Open
Abstract
The availability and cost of germline and somatic genetic testing have dramatically improved over the past two decades, enabling precision medicine approaches in oncology, with significant implications for prostate cancer (PCa) care. Roughly 12% of individuals with advanced disease are carriers of rare pathogenic germline variants that predispose to particularly aggressive and earlier-onset disease. Several of these variants are already established as clinically actionable by modern precision oncology therapeutics, while others may come to aid the selection of active surveillance, definitive local therapies, and systemic therapies. Concurrently, the number of common variants (ie, incorporated into polygenic risk scores) associated with PCa risk has continued to grow, but with several important considerations both at the intersection of race and ancestry and for early detection of aggressive disease. Family history has historically been used as a proxy for this inherited genetic risk of PCa, but recently emerging evidence examining this relation has shifted our understanding of how best to leverage this tool in PCa care. This review seeks to clarify and contextualize the existing and emerging precision oncology paradigms that use inherited genetic risk in PCa care, for both early detection and localized disease management.
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Affiliation(s)
- Andrew E Amini
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Keyan Salari
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
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7
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Micalizzi DS, Sequist LV, Haber DA. Deploying blood-based cancer screening. Science 2024; 383:368-370. [PMID: 38271495 DOI: 10.1126/science.adk1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
AI-based risk assessment may enable personalized blood-based multicancer screening.
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Affiliation(s)
- Douglas S Micalizzi
- Krantz Family Center for Cancer Research, Massachusetts General Hospital Cancer Center, Harvard Medical School, Charlestown, MA, USA
- Department of Medicine and Massachusetts General Hospital Cancer Center, Harvard Medical, School, Boston, MA, USA
| | - Lecia V Sequist
- Department of Medicine and Massachusetts General Hospital Cancer Center, Harvard Medical, School, Boston, MA, USA
| | - Daniel A Haber
- Krantz Family Center for Cancer Research, Massachusetts General Hospital Cancer Center, Harvard Medical School, Charlestown, MA, USA
- Department of Medicine and Massachusetts General Hospital Cancer Center, Harvard Medical, School, Boston, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
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8
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Kensler KH, Johnson R, Morley F, Albrair M, Dickerman BA, Gulati R, Holt SK, Iyer HS, Kibel AS, Lee JR, Preston MA, Vassy JL, Wolff EM, Nyame YA, Etzioni R, Rebbeck TR. Prostate cancer screening in African American men: a review of the evidence. J Natl Cancer Inst 2024; 116:34-52. [PMID: 37713266 PMCID: PMC10777677 DOI: 10.1093/jnci/djad193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Prostate cancer is the most diagnosed cancer in African American men, yet prostate cancer screening regimens in this group are poorly guided by existing evidence, given underrepresentation of African American men in prostate cancer screening trials. It is critical to optimize prostate cancer screening and early detection in this high-risk group because underdiagnosis may lead to later-stage cancers at diagnosis and higher mortality while overdiagnosis may lead to unnecessary treatment. METHODS We performed a review of the literature related to prostate cancer screening and early detection specific to African American men to summarize the existing evidence available to guide health-care practice. RESULTS Limited evidence from observational and modeling studies suggests that African American men should be screened for prostate cancer. Consideration should be given to initiating screening of African American men at younger ages (eg, 45-50 years) and at more frequent intervals relative to other racial groups in the United States. Screening intervals can be optimized by using a baseline prostate-specific antigen measurement in midlife. Finally, no evidence has indicated that African American men would benefit from screening beyond 75 years of age; in fact, this group may experience higher rates of overdiagnosis at older ages. CONCLUSIONS The evidence base for prostate cancer screening in African American men is limited by the lack of large, randomized studies. Our literature search supported the need for African American men to be screened for prostate cancer, for initiating screening at younger ages (45-50 years), and perhaps screening at more frequent intervals relative to men of other racial groups in the United States.
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Affiliation(s)
- Kevin H Kensler
- Department of Population Health Sciences, Weill Cornell Medical Center, New York, NY, USA
| | - Roman Johnson
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Faith Morley
- Department of Population Health Sciences, Weill Cornell Medical Center, New York, NY, USA
| | - Mohamed Albrair
- Department of Global Health, University of Washington, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Barbra A Dickerman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Sarah K Holt
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Hari S Iyer
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Adam S Kibel
- Department of Urology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jenney R Lee
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Mark A Preston
- Department of Urology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jason L Vassy
- VA Boston Healthcare System, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Erika M Wolff
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Yaw A Nyame
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Timothy R Rebbeck
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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9
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Abstract
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries (through 2020) and mortality data collected by the National Center for Health Statistics (through 2021). In 2024, 2,001,140 new cancer cases and 611,720 cancer deaths are projected to occur in the United States. Cancer mortality continued to decline through 2021, averting over 4 million deaths since 1991 because of reductions in smoking, earlier detection for some cancers, and improved treatment options in both the adjuvant and metastatic settings. However, these gains are threatened by increasing incidence for 6 of the top 10 cancers. Incidence rates increased during 2015-2019 by 0.6%-1% annually for breast, pancreas, and uterine corpus cancers and by 2%-3% annually for prostate, liver (female), kidney, and human papillomavirus-associated oral cancers and for melanoma. Incidence rates also increased by 1%-2% annually for cervical (ages 30-44 years) and colorectal cancers (ages <55 years) in young adults. Colorectal cancer was the fourth-leading cause of cancer death in both men and women younger than 50 years in the late-1990s but is now first in men and second in women. Progress is also hampered by wide persistent cancer disparities; compared to White people, mortality rates are two-fold higher for prostate, stomach and uterine corpus cancers in Black people and for liver, stomach, and kidney cancers in Native American people. Continued national progress will require increased investment in cancer prevention and access to equitable treatment, especially among American Indian and Alaska Native and Black individuals.
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Affiliation(s)
- Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia, USA
| | | | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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10
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Sweis J, Ofori B, Murphy AB. Concerns regarding prostate cancer screening guidelines in minority populations. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00765-0. [PMID: 38114597 DOI: 10.1038/s41391-023-00765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Jamila Sweis
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Bernice Ofori
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Adam B Murphy
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
- Division of Urology, Jesse Brown VA Medical Center, Chicago, IL, USA.
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11
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Vermeille M, Koster KL, Benzaquen D, Champion A, Taussky D, Kaulanjan K, Früh M. A Literature Review of Racial Disparities in Prostate Cancer Research. Curr Oncol 2023; 30:9886-9894. [PMID: 37999138 PMCID: PMC10670533 DOI: 10.3390/curroncol30110718] [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] [Received: 10/12/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Despite recent awareness of institutional racism, there are still important racial disparities in prostate cancer medical research. We investigated the historical development of research on racial disparities and bias. METHODS PubMed was searched for the term 'prostate cancer race' and added key terms associated with racial disparity. As an indicator of scientific interest in the topic, we analyzed whether the number of publications increased linearly as an indicator of growing interest. The linearity is expressed as R2. RESULTS The general search term "prostate cancer race" yielded 4507 publications. More specific search terms with ≥12 publications showing a higher scientific interest were found after 2005. The terms with the most publications when added to the general term were "genetic" (n = 1011), "PSA" (n = 995), and "detection" (n = 861). There was a linear increase in publications for "prostate cancer race" (R2 = 0.75) since 1980. Specific terms added to the general terms with a high linear increase (R2 ≥ 0.7) were "screening" (R2 = 0.82), "detection" (R2 = 0.72), "treatment access" (R2 = 0.71), and "trial underrepresentation" (R2 = 0.71). However, only a few studies have investigated its association with sexual activity. A combination with "sexual" showed 157 publications but only two years with ≥12 publications/year. CONCLUSION The terms "genetic", "PSA", and "detection" have been the focus of recent research on racial differences in prostate cancer. We found that old stereotypes are still being mentioned but seem to find little interest in the current literature. Further research interest was found in "treatment access". Recently, interest in socioeconomic factors has decreased.
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Affiliation(s)
- Matthieu Vermeille
- Genolier Swiss Radio-Oncology Network, Clinique de Genolier, 1272 Genolier, Switzerland;
| | - Kira-Lee Koster
- Department of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland; (K.-L.K.); (M.F.)
| | - David Benzaquen
- Radiation Oncology, Hôpital de La Tour, 1217 Meyrin, Switzerland; (D.B.); (A.C.)
| | - Ambroise Champion
- Radiation Oncology, Hôpital de La Tour, 1217 Meyrin, Switzerland; (D.B.); (A.C.)
| | - Daniel Taussky
- Radiation Oncology, Hôpital de La Tour, 1217 Meyrin, Switzerland; (D.B.); (A.C.)
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H3Y2V4, Canada
| | - Kevin Kaulanjan
- Department of Urology, Université des Antilles, CHU de Guadeloupe, 97110 Pointe-à-Pitre, France;
| | - Martin Früh
- Department of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland; (K.-L.K.); (M.F.)
- Department of Medical Oncology, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
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12
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Gulati R, Nyame YA, Lange JM, Shoag JE, Tsodikov A, Etzioni R. Racial disparities in prostate cancer mortality: a model-based decomposition of contributing factors. J Natl Cancer Inst Monogr 2023; 2023:212-218. [PMID: 37947332 PMCID: PMC10637024 DOI: 10.1093/jncimonographs/lgad018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/22/2023] [Accepted: 06/27/2023] [Indexed: 11/12/2023] Open
Abstract
To investigate the relative contributions of natural history and clinical interventions to racial disparities in prostate cancer mortality in the United States, we extended a model that was previously calibrated to Surveillance, Epidemiology, and End Results (SEER) incidence rates for the general population and for Black men. The extended model integrated SEER data on curative treatment frequencies and cancer-specific survival. Starting with the model for all men, we replaced up to 9 components with corresponding components for Black men, projecting age-standardized mortality rates for ages 40-84 years at each step. Based on projections in 2019, the increased frequency of developing disease, more aggressive tumor features, and worse cancer-specific survival in Black men diagnosed at local-regional and distant stages explained 38%, 34%, 22%, and 8% of the modeled disparity in mortality. Our results point to intensified screening and improved care in Black men as priority areas to achieve greater equity.
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Affiliation(s)
- Roman Gulati
- Division of Public Health Sciences, Biostatistics Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Yaw A Nyame
- Division of Public Health Sciences, Biostatistics Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA
| | - Jane M Lange
- Division of Public Health Sciences, Biostatistics Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Jonathan E Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Alex Tsodikov
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Biostatistics Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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13
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Jani C, Mouchati C, Abdallah N, Mariano M, Jani R, Salciccioli JD, Marshall DC, Singh H, Sheng I, Shalhoub J, McKay RR. Trends in prostate cancer mortality in the United States of America, by state and race, from 1999 to 2019: estimates from the centers for disease control WONDER database. Prostate Cancer Prostatic Dis 2023; 26:552-562. [PMID: 36522462 DOI: 10.1038/s41391-022-00628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND In the United States of America (USA), prostate cancer (PC) is the most common cancer in men and the second cause of cancer mortality. Black men (BM) have a higher incidence and worse mortality when compared to white men (WM). We compared trends in PC mortality in the USA by race and state from 1999 to 2019. METHODS We extracted PC mortality data from the Centers for Disease Control (CDC) WONDER database using the International Classification of Diseases (ICD) 10 code C61. Age-Standardized Mortality Rates (ASMR) were divided into racial groups and reported by year and state. Due to the lack of available data in many states, analyses were conducted only for WM and BM using Joinpoint regression for trend comparisons. RESULTS Between 1999-2019, ASMR decreased at the national level in Black (-44.6%), Asian (-44.8%), White (-31.8%), and American Indian or Alaskan native men (-19.0%). ASMR decreased in all states for both races. The greatest drop in ASMR was in Kentucky (-47.0%) for WM and Delaware (-57.8%) for BM. In 2019, ASMRs in BM (13.4/100 000) were significantly higher than WM (7.3/100 000), American Indian or Alaskan Native (3.2/100 000), and Asian men (3.2/100 000) (p < 0.001). The highest ASMRs were in Nebraska (33.5/100 000) for BM and Alaska (11/100 000) for WM. CONCLUSIONS During the last 20 years, the PC mortality rate dropped in all states for all races, suggesting an advancement in management strategies. Although a higher decrease in ASMR was observed in BM, ASMR remain higher among BM. ASMRs were also found to be increasing in many states post USPSTF guideline change (2012), indicating a need for more education around optimized prostate cancer screening.
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Affiliation(s)
- Chinmay Jani
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Christian Mouchati
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nour Abdallah
- Department of Urology Research, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa Mariano
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ruchi Jani
- Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Justin D Salciccioli
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Dominic C Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Harpreet Singh
- Division of Pulmonary and Critical Care, University of Wisconsin, Milwaukee, WI, USA
| | - Iris Sheng
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Hematology and Oncology, Mount Auburn Hospital, Cambridge, MA, USA
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rana R McKay
- University of California San Diego, San Diego, CA, 2021, USA
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14
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Benedict MOA, Steinberg WJ, Claassen FM, Mofolo N. Strategies to enhance the approach to prostate cancer screening of South African black men in the Free State: a Delphi study. J Public Health Afr 2023; 14:2333. [PMID: 37680870 PMCID: PMC10481904 DOI: 10.4081/jphia.2023.2333] [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: 09/27/2022] [Accepted: 12/19/2022] [Indexed: 09/09/2023] Open
Abstract
Background The incidence and mortality rates of prostate cancer (PCa) are disproportionately on the increase among South African black men. Recent studies show a greater net benefit of prostate-specific antigen screening of black men compared with the general population. There are, however, knowledge, attitude, and practice (KAP) gaps among primary healthcare providers (HCPs) and users (black men) on PCa screening. Likewise, there is a scarcity of research on strategies to address these gaps. Objective This study sought to determine complementing strategies to enhance the approach to PCa screening of African men in the Free State, South Africa, from the perspectives of primary HCPs and users. Methods This study utilized a three-round modified Delphi survey to achieve its aim. Consensus was determined by an a priori threshold of ≥70% of agreement. Results The survey involved a multidisciplinary panel of 19 experts. The consensus was reached on 34 items (strategies) to enhance the approach to PCa screening in the study setting. Community health education strategies were proffered, relating to relevant topics, methods, venues of delivery, and persons to deliver the education. Continuing education topics and methods of instruction were suggested for primary HCPs. Conclusions In view of the existing KAP gaps in PCa screening among primary HCPs and users (black men), an expert consensus was determined, on complementing strategies to enhance the approach to PCa screening of South African black men in the study setting.
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Affiliation(s)
| | | | - Frederik M. Claassen
- Department of Urology, Faculty of Health Sciences, University of the Free State, Bloemfontein
| | - Nathaniel Mofolo
- School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
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15
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Fu J, Fu C, Wang RS, Geynisman DM, Ghatalia P, Lynch SM, Harrison SR, Tagai EK, Ragin C. Current Status and Future Direction to Address Disparities in Diversity, Equity, and Inclusion in Prostate Cancer Care. Curr Oncol Rep 2023; 25:699-708. [PMID: 37010786 PMCID: PMC10068208 DOI: 10.1007/s11912-023-01399-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE OF REVIEW Disparities in prostate cancer care and outcomes have been well recognized for decades. The purpose of this review is to methodically highlight known racial disparities in the care of prostate cancer patients, and in doing so, recognize potential strategies for overcoming these disparities moving forward. RECENT FINDINGS Over the past few years, there has been a growing recognition and push towards addressing disparities in cancer care. This has led to improvements in care delivery trends and a narrowing of racial outcome disparities, but as we highlight in the following review, there is more to be addressed before we can fully close the gap in prostate cancer care delivery. While disparities in prostate cancer care are well recognized in the literature, they are not insurmountable, and progress has been made in identifying areas for improvement and potential strategies for closing the care gap.
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Affiliation(s)
- Jerry Fu
- Duke University, Durham, NC, USA
| | - Chen Fu
- Fox Chase Cancer Center, Philadelphia, PA, USA
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16
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Gillette C, Locklear T, Bell R, Bates N, Ostermann J, Reuland D, Foley K, Lashmit C, Crandall S. American Indian/Alaska Native men are less likely to receive prostate-specific antigen testing and digital rectal exams from primary care providers than White men: a secondary analysis of the National Ambulatory Medical Care Survey from 2012-2018. Cancer Causes Control 2023:10.1007/s10552-023-01714-x. [PMID: 37217700 PMCID: PMC10363029 DOI: 10.1007/s10552-023-01714-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE (1) Identify the proportion of primary care visits in which American Indian/Alaska Native (AI/AN) men receive a prostate-specific antigen test (PSAT)and/or a digital rectal exam (DRE), (2) describe characteristics of primary care visits in which AI/AN receive PSA and/or DRE, and (3) identify whether AI/AN receive PSA and/or DRE less often than non-Hispanic White (nHW) men. METHODS This was a secondary analysis of the National Ambulatory Medical Care Survey (NAMCS) during 2013-2016 and 2018 and the NAMCS Community Health Center (CHC) datasets from 2012-2015. Weighted bivariate and multivariable tests analyzed the data to account for the complex survey design. RESULTS For AI/AN men, 1.67 per 100 visits (95% CI = 0-4.24) included a PSATs (or PSAT) and 0 visits included a DRE between 2013-2016 and 2018. The rate of PSA for non-AI/AN men was 9.35 per 100 visits (95% CI = 7.78-10.91) and 2.52 per 100 visits (95% CI = 1.61-3.42) for DRE. AI/AN men were significantly less likely to receive a PSA than nHW men (aOR = 0.09, 95% CI = 0.01-0.83). In CHCs, AI/AN men experienced 4.26 PSAT per 100 visits (95% CI = 0.96-7.57) compared to 5.00 PSAT per 100 visits (95% CI = 4.40-5.68) for non-AI/AN men. DRE rates for AI/AN men was 0.63 per 100 visits (95% CI = 0-1.61) compared to 1.05 per 100 (95% CI = 0.74-1.37) for non-AI/AN men. There was not a statistically significant disparity in the CHC data regarding PSA (OR = 0.91, 95% CI = 0.42-1.98) or DRE (OR = 0.75, 95% CI = 0.15-3.74), compared to nHW men. CONCLUSION Efforts are needed to better understand why providers may not use PSA and DRE with AI/AN men compared to nHW men.
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Affiliation(s)
- Chris Gillette
- Department of PA Studies, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA.
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Tony Locklear
- Department of Public Health Education, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Ronny Bell
- Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Nathan Bates
- Department of PA Studies, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA
| | - Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniel Reuland
- Department of General Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kristie Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Cheyenne Lashmit
- High Point Family Practice, Atrium Health Wake Forest Baptist, High Point, NC, USA
| | - Sonia Crandall
- Department of PA Studies, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA
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17
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Wang Y, Morrissey JJ, Gupta P, Chauhan P, Pachynski RK, Harris PK, Chaudhuri A, Singamaneni S. Preservation of Proteins in Human Plasma through Metal-Organic Framework Encapsulation. ACS APPLIED MATERIALS & INTERFACES 2023; 15:18598-18607. [PMID: 37015072 PMCID: PMC10484212 DOI: 10.1021/acsami.2c21192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Traditional cold chain systems of collection, transportation, and storage of biofluid specimens for eventual analysis pose a huge financial and environmental burden. These systems are impractical in pre-hospital and resource-limited settings, where refrigeration and electricity are not reliable or even available. Here, we develop an innovative technology using metal-organic frameworks (MOFs), a novel class of organic-inorganic hybrids with high thermal stability, as encapsulates for preserving the integrity of protein biomarkers in biofluids under ambient or non-refrigerated storage conditions. We encapsulate prostate-specific antigen (PSA) in whole patient plasma using hydrophilic zeolitic imidazolate framework-90 (ZIF-90) for preservation at 40 °C for 4 weeks and eventual on-demand reconstitution for antibody-based assays with recovery above 95% compared to storage at -20 °C. Without ZIF-90 encapsulation, only 10-30% of the PSA immunoactivity remained. Furthermore, we demonstrate encapsulation of multiple cancer biomarker proteins in whole patient plasma using ZIF-8 or ZIF-90 encapsulants for eventual on-demand reconstitution and analysis after 1 week at 40 °C. Overall, MOF encapsulation of patient biofluids is important as climate change may be affecting the stability and increase costs of maintaining biospecimen cold chain custody for the collection, transportation, and storage of biospecimens prior to analysis or for biobanking regardless of any countries' affluence.
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Affiliation(s)
- Yixuan Wang
- Department of Mechanical Engineering and Materials Science, Institute of Materials Science and Engineering, Washington University in St. Louis, St Louis, MO 63130, United States
| | - Jeremiah J. Morrissey
- Department of Anesthesiology, Division of Clinical and Translational Research, Washington University School of Medicine in St. Louis, St Louis, MO 63110, United States
- Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, St Louis, MO 63110, United States
| | - Prashant Gupta
- Department of Mechanical Engineering and Materials Science, Institute of Materials Science and Engineering, Washington University in St. Louis, St Louis, MO 63130, United States
| | - Pradeep Chauhan
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, MO 63110, United States
| | - Russell K. Pachynski
- Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, St Louis, MO 63110, United States
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St Louis, MO 63110, United States
| | - Peter K. Harris
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, MO 63110, United States
| | - Aadel Chaudhuri
- Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, St Louis, MO 63110, United States
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, MO 63110, United States
- Department of Biomedical Engineering, Washington University School of Medicine in St. Louis, St Louis, MO 63110, United States
- Department of Genetics, Washington University School of Medicine in St. Louis, St Louis, MO 63110, United States
- Department of Computer Science and Engineering, Washington University in St. Louis, St Louis, MO 63130, United States
| | - Srikanth Singamaneni
- Department of Mechanical Engineering and Materials Science, Institute of Materials Science and Engineering, Washington University in St. Louis, St Louis, MO 63130, United States
- Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, St Louis, MO 63110, United States
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18
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Benedict MO, Steinberg WJ, Claassen FM, Mofolo N, van Rooyen C. Knowledge, attitude and practice on screening and early diagnosis of prostate cancer of primary health care providers in the Free State. Afr J Prim Health Care Fam Med 2023; 15:e1-e12. [PMID: 36861921 PMCID: PMC9982489 DOI: 10.4102/phcfm.v15i1.3688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Prostate cancer is topmost in terms of incidence and mortality among men in sub-Saharan Africa, including South Africa. Prostate cancer screening is beneficial only to certain categories of men, making a rational screening approach necessary. AIM This study aimed to assess the knowledge, attitudes and practice (KAP) regarding prostate cancer screening among primary health care (PHC) providers in the Free State, South Africa. SETTING Selected district hospitals, local clinics and general practice rooms. METHODS This was a cross-sectional analytical survey. Participating nurses and community health workers (CHWs) were selected through stratified random sampling. All available medical doctors and clinical associates were approached to participate, totalling 548 participants. Relevant information was obtained from these PHC providers using self-administered questionnaires. Both descriptive and analytical statistics were computed using Statistical Analysis System (SAS) Version 9. A p-value 0.05 was considered significant. RESULTS Most participants had poor knowledge (64.8%), neutral attitudes (58.6%) and poor practice (40.0%). Female PHC providers, lower cadre nurses and CHWs had lower mean knowledge scores. Not participating in prostate cancer-related continuing medical education was associated with poor knowledge (p 0.001), negative attitudes (p = 0.047) and poor practice (p 0.001). CONCLUSION This study established appreciable KAP gaps relating to prostate cancer screening among PHC providers. Identified gaps should be addressed through the preferred teaching and learning strategies suggested by the participants.Contribution: This study establishes the need to address KAP gaps regarding prostate cancer screening among PHC providers; therefore necessitating the capacity-building roles of district family physicians.
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Affiliation(s)
- Matthew O.A. Benedict
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Wilhelm J. Steinberg
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Frederik M. Claassen
- Department of Urology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Nathaniel Mofolo
- Faculty of Health Sciences, School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
| | - Cornel van Rooyen
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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19
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Otiono K, Nkonge B, Olaiya OR, Pierre S. Dépistage du cancer de la prostate chez les hommes noirs au Canada : Argument en faveur des soins stratifiés en fonction du risque. CMAJ 2023; 195:E101-E105. [PMID: 36649960 PMCID: PMC9851637 DOI: 10.1503/cmaj.220452-f] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Kikachukwu Otiono
- Faculté de médecine Michael G. DeGroote (Otiono), Exploration et commercialisation biomédicales (Nkonge) et Division de chirurgie plastique (Olaiya), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; Division d'urologie (Pierre), Hôpital Queensway Carleton, Ottawa, Ont.
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20
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Prostate cancer risk, screening and management in patients with germline BRCA1/2 mutations. Nat Rev Urol 2023; 20:205-216. [PMID: 36600087 DOI: 10.1038/s41585-022-00680-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 01/05/2023]
Abstract
Mutations in the BRCA1 and BRCA2 tumour suppressor genes are associated with prostate cancer risk; however, optimal screening protocols for individuals with these mutations have been a subject of debate. Several prospective studies of prostate cancer incidence and screening among BRCA1/2 mutation carriers have indicated at least a twofold to fourfold increase in prostate cancer risk among carriers of BRCA2 mutations compared with the general population. Moreover, BRCA2 mutations are associated with more aggressive, high-grade disease characteristics at diagnosis, more aggressive clinical behaviour and greater prostate cancer-specific mortality. The risk for BRCA1 mutations seems to be attenuated compared with BRCA2. Prostate-specific antigen (PSA) measurement or prostate magnetic resonance imaging (MRI) alone is an imperfect indicator of clinically significant prostate cancer; therefore, BRCA1/2 mutation carriers might benefit from refined risk stratification strategies. However, the long-term impact of prostate cancer screening is unknown, and the optimal management of BRCA1/2 carriers with prostate cancer has not been defined. Whether timely localized therapy can improve overall survival in the screened population is uncertain. Long-term results of prospective studies are awaited to confirm the optimal screening strategies and benefits of prostate cancer screening among BRCA1/2 mutation carriers, and whether these approaches ultimately have a positive impact on survival and quality of life in these patients.
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21
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Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin 2023; 73:17-48. [PMID: 36633525 DOI: 10.3322/caac.21763] [Citation(s) in RCA: 4930] [Impact Index Per Article: 4930.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 01/13/2023] Open
Abstract
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries and mortality data collected by the National Center for Health Statistics. In 2023, 1,958,310 new cancer cases and 609,820 cancer deaths are projected to occur in the United States. Cancer incidence increased for prostate cancer by 3% annually from 2014 through 2019 after two decades of decline, translating to an additional 99,000 new cases; otherwise, however, incidence trends were more favorable in men compared to women. For example, lung cancer in women decreased at one half the pace of men (1.1% vs. 2.6% annually) from 2015 through 2019, and breast and uterine corpus cancers continued to increase, as did liver cancer and melanoma, both of which stabilized in men aged 50 years and older and declined in younger men. However, a 65% drop in cervical cancer incidence during 2012 through 2019 among women in their early 20s, the first cohort to receive the human papillomavirus vaccine, foreshadows steep reductions in the burden of human papillomavirus-associated cancers, the majority of which occur in women. Despite the pandemic, and in contrast with other leading causes of death, the cancer death rate continued to decline from 2019 to 2020 (by 1.5%), contributing to a 33% overall reduction since 1991 and an estimated 3.8 million deaths averted. This progress increasingly reflects advances in treatment, which are particularly evident in the rapid declines in mortality (approximately 2% annually during 2016 through 2020) for leukemia, melanoma, and kidney cancer, despite stable/increasing incidence, and accelerated declines for lung cancer. In summary, although cancer mortality rates continue to decline, future progress may be attenuated by rising incidence for breast, prostate, and uterine corpus cancers, which also happen to have the largest racial disparities in mortality.
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Affiliation(s)
- Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Kimberly D Miller
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Nikita Sandeep Wagle
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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22
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Benedict MO, Steinberg WJ, Claassen FM, Mofolo N, van Rooyen C. Knowledge, beliefs and intentions of African men in the Free State about prostate cancer screening. Health SA 2022; 27:2081. [PMID: 36570089 PMCID: PMC9772771 DOI: 10.4102/hsag.v27i0.2081] [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: 06/06/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background African men are less likely to participate in prostate cancer (PCa) screening, which may be beneficial to some of them. Gaps in knowledge, cultural factors and beliefs are associated with their screening intentions. Aim To determine the knowledge, cultural factors and screening intentions of African males regarding PCa screening. Setting The study was conducted among African men attending randomly selected primary healthcare clinics in the Free State province. Methods An analytical, cross-sectional survey using self-administered questionnaires developed in line with the Theory of Planned Behaviour constructs. Results Of the 389 respondents, 18.3% had ever been screened for PCa with prostate-specific antigen (PSA) testing and 6.2% by digital rectal examination (DRE). About a quarter (24.4%) of the respondents had knowledge scores ≥ 50%. Factors associated with greater intent to screen for PCa were lower degree of fear/apprehension of PCa screening (mean score = 2.03; p < 0.001), higher perceived benefits of PCa screening (mean score = 2.69; p = 0.002), lower perceived situational barriers to PCa screening (mean score = 2.03; p = 0.006) and higher perceived risk of getting PCa (mean score = 2.66; p = 0.024). Conclusion The observed low level of knowledge and practice of PCa screening among the respondents could be enhanced through PCa awareness strategies targeted at these men or those that could influence their decision making, especially healthcare providers. Factors that enhance screening intentions should be promoted. Contribution This study improves on the scarce literature on factors associated with African men's PCa screening intention.
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Affiliation(s)
- Matthew O.A. Benedict
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Wilhelm J. Steinberg
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Frederik M. Claassen
- Department of Urology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Nathaniel Mofolo
- School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Cornel van Rooyen
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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23
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Otiono K, Nkonge B, Olaiya OR, Pierre S. Prostate cancer screening in Black men in Canada: a case for risk-stratified care. CMAJ 2022; 194:E1411-E1415. [PMID: 36280242 PMCID: PMC9616133 DOI: 10.1503/cmaj.220452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kikachukwu Otiono
- Michael G. DeGroote School of Medicine (Otiono), Biomedical Discovery and Commercialization (Nkonge) and Division of Plastic Surgery (Olaiya), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Division of Urology (Pierre), Queensway Carleton Hospital, Ottawa, Ont.
| | - Brenda Nkonge
- Michael G. DeGroote School of Medicine (Otiono), Biomedical Discovery and Commercialization (Nkonge) and Division of Plastic Surgery (Olaiya), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Division of Urology (Pierre), Queensway Carleton Hospital, Ottawa, Ont
| | - Oluwatobi R Olaiya
- Michael G. DeGroote School of Medicine (Otiono), Biomedical Discovery and Commercialization (Nkonge) and Division of Plastic Surgery (Olaiya), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Division of Urology (Pierre), Queensway Carleton Hospital, Ottawa, Ont
| | - Sean Pierre
- Michael G. DeGroote School of Medicine (Otiono), Biomedical Discovery and Commercialization (Nkonge) and Division of Plastic Surgery (Olaiya), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Division of Urology (Pierre), Queensway Carleton Hospital, Ottawa, Ont
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24
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Arenas-Gallo C, Owiredu J, Weinstein I, Lewicki P, Basourakos SP, Vince R, Al Hussein Al Awamlh B, Schumacher FR, Spratt DE, Barbieri CE, Shoag JE. Race and prostate cancer: genomic landscape. Nat Rev Urol 2022; 19:547-561. [PMID: 35945369 DOI: 10.1038/s41585-022-00622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/09/2022]
Abstract
In the past 20 years, new insights into the genomic pathogenesis of prostate cancer have been provided. Large-scale integrative genomics approaches enabled researchers to characterize the genetic and epigenetic landscape of prostate cancer and to define different molecular subclasses based on the combination of genetic alterations, gene expression patterns and methylation profiles. Several molecular drivers of prostate cancer have been identified, some of which are different in men of different races. However, the extent to which genomics can explain racial disparities in prostate cancer outcomes is unclear. Future collaborative genomic studies overcoming the underrepresentation of non-white patients and other minority populations are essential.
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Affiliation(s)
- Camilo Arenas-Gallo
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jude Owiredu
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Ilon Weinstein
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Patrick Lewicki
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Spyridon P Basourakos
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Randy Vince
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Bashir Al Hussein Al Awamlh
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.,Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fredrick R Schumacher
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Christopher E Barbieri
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Jonathan E Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA. .,Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA. .,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
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25
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Welch HG, Adamson AS. Should Recommendations for Cancer Screening Differentiate on Race? NEJM EVIDENCE 2022; 1:EVIDe2200070. [PMID: 38319234 DOI: 10.1056/evide2200070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Should Recommendations for Cancer Screening Differentiate on Race?Cancer screening recommendations routinely differentiate among individuals on the basis of their age. Starting and stopping ages are an attempt to hit the screening sweet spot: the effort to capture a population at relatively high risk of dying from the target cancer (i.e., not too young), while still at relatively low risk of dying from something else (i.e., not too old). Recommendations may also differentiate on the basis of sex (e.g., breast cancer screening is only recommended for women, although men do die from the disease) or a history of high-risk behaviors (e.g., lung cancer screening in heavy smokers).
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Affiliation(s)
- H Gilbert Welch
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston
| | - Adewole S Adamson
- Division of Dermatology, Dell Medical School, University of Texas, Austin, TX
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