Abrogation of survival disparity between insured and uninsured individuals after the USPSTF's 2012 prostate-specific antigen-based prostate cancer screening recommendation.

Abstract

77 Background: In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA)-based screening for prostate cancer. Studies have found that insured patients with prostate cancer have better outcomes than uninsured patients. We examined the recommendation’s effects on survival disparities based on insurance status as well as socioeconomic quintile, marital status, and housing (urban/rural). Methods: Using the SEER18 database, we examined prostate cancer-specific survival (PCSS) based on diagnostic time period and one of four factors: insurance status, socioeconomic quintile, marital status, and housing (urban/rural). The SEER-designated socioeconomic quintile was based on variables including median household income and education index. Patients were designated as belonging to the pre-USPSTF era if diagnosed in 2010-2012 or post-USPSTF era if diagnosed in 2014-2016. Disparities were measured with the Cox proportional hazards model. Results: We identified 282,994 patients diagnosed with prostate cancer. During the pre-USPSTF era, uninsured patients experienced worse PCSS compared to insured patients (adjusted HR 1.29, 95% CI 1.06-1.58, p = 0.01). This survival disparity narrowed during the post-USPSTF era as a result of decreased PCSS among insured patients combined with unchanged PCSS among uninsured patients. Moreover, the survival disparity was no longer observed during the post-USPSTF era (aHR 0.91, 95% CI 0.61-1.38, p = 0.67). The survival disparity based on socioeconomic quintile also narrowed but remained significant. In contrast, the survival disparity based on marital status widened, while housing status was not associated with survival disparities in either era. Conclusions: From the pre- to the post-USPSTF era, insured patients with prostate cancer observed a significant decrease in survival that made their survival outcomes similar to that of uninsured patients. Although the underlying reasons are not clear, the USPSTF’s 2012 PSA screening recommendation may have hindered insured patients from being regularly screened for prostate cancer and selectively led to worse outcomes for insured patients without improving the survival of uninsured patients.[Table: see text]

The Key to Addressing Disparities in Prostate Cancer: Urologists in Advocacy?

“…Since studies prior to the recommendation reported that Black patients were almost half as likely to undergo PSA screening than White patients, our findings suggest that lower rates of PSA screening among Black men in the pre-USPSTF era may be an important contributing factor to prostate cancer survival disparities between White and Black men. 3…”

“…Since studies prior to the recommendation reported that Black patients were almost half as likely to undergo PSA screening than White patients, our findings suggest that lower rates of PSA screening among Black men in the pre-USPSTF era may be an important contributing factor to prostate cancer survival disparities between White and Black men. 3 In addition to Black patients, uninsured patients comprise a population significantly affected by inequities in prostate cancer outcomes and experience mortality rates almost twice as high as those of insured patients. 4 In a follow-up publication, we found that the USPSTF's 2012 recommendation similarly resulted in the disappearance of survival disparities between insured and uninsured patients.…”

Growing the Next Generation of Oncology Researchers and Oncologists

“…Of the 22 abstracts selected for oral presentations, 13, nearly 60%, were presented by trainees (Fig 1). [1][2][3][4][5][6][7][8][9][10][11][12][13] Five of these trainees were recipients of ASCO's Merit Awards. 14 Presenters came from a variety of backgrounds and included medical students, residents, clinical fellows, master students, predoctoral students, postdoctoral trainees, and junior faculty on career development awards.…”

Damaged Masculinity: How Honor Endorsement Can Influence Prostate Cancer Screening Decision-Making and Prostate Cancer Mortality Rates

“…Although recently there appears to be a controversy regarding the predictive validity of prostate cancer screenings, as well as some contention regarding the association between screening procedures and prostate cancer mortality rates (see Andriole et al, 2009; Getaneh et al, 2020; Pinsky et al, 2019), population studies of prostate cancer screenings have consistently shown a long-term decrease in prostate cancer mortality rates due to screening attendance (Carlsson et al, 2017; Hugosson et al, 2019; Osses et al, 2019; Tabei et al, 2020). Moreover, when the Centers for Disease Control and Prevention (CDC) downgraded their prostate cancer screening recommendation to a “D” grade, evidence suggested that this change led to increases in metastatic prostate cancer and prostate cancer mortality rates due to lower levels of screening attendance and, therefore, decreased detection of dangerous, metastatic prostate cancer (Butler et al, 2020; Joshi & Filson, 2020; I. E. Kim et al, 2020).…”