The authors thank Drs. Christine Berg and Philip Prorok, Division of Cancer Prevention, National Cancer Institute, the Screening Center investigators and staff of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, Mr. Tom Riley and staff, Information Management Services, Inc., and Ms. Barbara O'Brien and staff, Westat, Inc. Most important, we acknowledge the study participants for their contributions to making this study possible.
Association between race and follow-up diagnostic care after a positive prostate cancer screening test in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial
Version of Record online: 4 APR 2013
Copyright © 2013 American Cancer Society
Volume 119, Issue 12, pages 2223–2229, 15 June 2013
How to Cite
Barocas, D. A., Grubb, R., Black, A., Penson, D. F., Fowke, J. H., Andriole, G. and Crawford, E. D. (2013), Association between race and follow-up diagnostic care after a positive prostate cancer screening test in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial. Cancer, 119: 2223–2229. doi: 10.1002/cncr.28042
See related editorial on pages 2206–8, this issue.
- Issue online: 4 JUN 2013
- Version of Record online: 4 APR 2013
- Manuscript Accepted: 18 DEC 2012
- Manuscript Revised: 12 DEC 2012
- Manuscript Received: 12 AUG 2012
- prostate cancer;
- health care disparity
Follow-through of a positive screening test is necessary to reap the potential benefits of cancer screening. Racial variation in follow-through diagnostic care may underlie a proportion of the known disparity in prostate cancer mortality. The authors used data from the screening arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial to determine whether race is associated with the use of follow-up diagnostic testing after a positive initial screening evaluation.
Men who had a prostate-specific antigen (PSA) level >4 ng/mL at any time during the study were included. The proportion of men who underwent follow-up evaluation with a repeat PSA, a prostate biopsy, or either test within 9 months was determined, and the authors tested for differences in follow-through according to race using mixed-effects multivariate models with a random effect for accrual site to account for clustering. Models were stratified according to age (<65 years and ≥65 years).
Among 6294 men who had a PSA elevation during the study period, 70% underwent a repeat PSA or prostate biopsy within 9 months. Non-Hispanic black men aged <65 years had 45% lower odds of undergoing a repeat PSA test or prostate biopsy compared with non-Hispanic white men (odds ratio, 0.55; 95% confidence interval, 0.37-0.82), whereas there was no racial difference in follow-through among older men.
The current results suggest that limitations in access to care among non-Hispanic black men under the age of Medicare eligibility may underlie the paradoxically low use of follow-through diagnostic care among non-Hispanic black men in the United States. Cancer 2013;119:2223–2229. © 2013 American Cancer Society.