ASPO Abstracts
PSA Testing and Prostate Cancer Incidence Following the 2012 Update to the U.S. Preventive Services Task Force Prostate Cancer Screening Recommendation: Implications for Racial/Ethnic Disparities
Category: Cancer Health Disparities
Conference Year: 2020
Abstract Body:
Purpose
The 2012 U.S. Preventive Services Task Force (USPSTF) recommendation against prostate specific antigen
(PSA) testing led to a decrease in prostate cancer screening, but its impact on prostate cancer racial/ethnic
disparities remains unclear.
Methods
The proportion of men ages 40-74 years who received a routine PSA test in the past year was estimated over
time in the Behavioral Risk Factor Surveillance System (BRFSS; 2012-2018) and the National Health Interview
Survey (NHIS; 2005-2018). Screening trends by race/ethnicity were evaluated using logistic regression models
to estimate odds ratios (ORs) of screening adjusting for socioeconomic and healthcare-related factors.
Prostate cancer incidence rates and rate ratios (IRRs) by race/ethnicity were estimated in the Surveillance,
Epidemiology and End Results (SEER) registry data over time (2004-2016).
Results
In the 2012 BRFSS, PSA testing rates were highest among non-Hispanic white (NHW) men (32.3%), followed
by non-Hispanic black (NHB; 30.3%), Hispanic (21.8%), and Asian/Pacific Islander men (17.7%). The absolute
screening frequency declined by 9.5% overall from 2012 to 2018, with a greater decline among NHB (11.6%)
than NHW men (9.3%). Adjusting for socioeconomic and healthcare-related factors, the relative decline was
greater among NHB (OR per year=0.86, 95%CI 0.84-0.88) than NHW men (OR=0.89, 95%CI0.89-0.90; p-
het.=0.005), driven by a steeper drop among NHB men ages 40-54. In the NHIS, the 2012 update was
associated with a 35% decrease in the odds of screening (OR=0.65, 95%CI 0.51-0.82), though there was no
annual change since 2012 (OR=1.00, 95% CI0.98-1.03). Trends in the NHIS did not differ by race/ethnicity.
The NHB:NHW IRR for total prostate cancer increased from 1.73 in 2011 to 1.87 in 2012 and has remained
elevated, driven by differences in the incidence of localized tumors. Disparity IRRs have been consistent since
2012 for other racial/ethnic populations.
Conclusions
Although the frequency of prostate cancer screening varies by race/ethnicity, the impact of the 2012 USPSTF
recommendation against PSA testing on screening trends did not robustly differ by race/ethnicity. Following
2012, there was a modest increase in the disparity for localized prostate cancer incidence between NHB and
NHW men.
Keywords: Prostate cancer; Prostate specific antigen; Screening; Cancer health disparities