Patient perspectives of prostate cancer screening vary by race following 2018 guideline changes

Abstract

Background:The 2018 US Preventive Services Task Force guidelines recommend individualizing prostate cancer screening in 55-to 69-year-old men. Given the higher incidence of prostate cancer in African American (AA) compared to non-Hispanic White (NHW) men, this study compared reported rates of prostatespecific antigen (PSA) screening hypothesizing that it would not be commensurate with the relative risk between these two groups.Methods: Using the 2020 Behavioral Risk Factor Surveillance System, we identified 43,685 men (40,301 NHW and 3384 AA) interviewed about PSA screening.Results: AA men had an odds ratio (OR) of 0.80 (95% confidence interval [CI], 0.69-0.93; p = .004) of reporting PSA screening; sequentially correcting for access to care, smoking, and age had minimal effect on this finding, but when correcting for income significantly attenuated this difference (OR, 0.95; 95% CI, 0.81-1.12).Further adding education level eliminated the effect size of AA race entirely with OR, 0.99 (95% CI, 0.84-1.17; p = .91). Further analysis found significant interaction between education and race, with college-educated AA men having 1.42 OR of receiving screening compared to college-educated NHW men.Conclusions: Despite prostate cancer being more common and having higher population-level mortality in AA than NHW men, PSA screening and education patterns do not reflect this increased risk even when adjusting for health access disparities. The authors' findings of significant effect from both income and education suggest that systemic racism is an important factor in the observed difference in PSA screening between AA men and NHW men. Lay summary:� In the United States, prostate cancer is more common in African American men � New guidelines from 2018 encourage physicians to consider risk factors in deciding whether or not to recommend screening, but overall African American men continue to be screened at a lower rate than non-Hispanic White men � This effect disappears when correcting for income and education level, suggesting that several factors including systemic racism, medical mistrust, and selfadvocacy may impact this observed difference 82 -Cancer.

The Risk Factors and Screening Uptake for Prostate Cancer: A Scoping Review

“…However, Chang [41] identified no significant risk with age and prostate cancer. In terms of race and ethnicity, African American [34,36,55,62,68,71,72,80,81], Caribbean [36,66] and black men [35,36,57,70,77,82] were more likely to develop prostate cancer, while Adler et al [74] identified no significant difference in ethnicity. Diet and the intake of red meat [44,45,53], high saturated fats [39,40,43,45,51,63], sugars (sweets and beverages) [58] and a high sodium diet were identified as risks of developing prostate cancer [45].…”

“…However, the relationship between hormones and vasectomies and prostate cancer was questioned, with Sasagawa and Nakada [60] finding no evidence of a correlation with hormones and Childre et al [43] finding no evidence of a correlation with vasectomies. Geographical location (e.g., Vietnam) can serve as a predisposing factor for prostate cancer [46,63,64] and may be due to access issues [51,56,66,[81][82][83][84]. Finally, men exposed to hazards (e.g., benzene, toluene, pesticides, fuels, solvents, radiation, agent orange) were identified as being at an increased risk of prostate cancer [34,54,62,74], and generally military roles were highlighted [54,74].…”

“…The evidence points to racism and poverty; cultural, religious, language and communication barriers; high medical expenses; and geographical locations and knowledge/awareness as factors that hinder men from assessing prostate cancer screening [35,56,71,80,[82][83][84]90,92,[96][97][98]. Within screening uptake, the decision-making process was a key factor, with patients (men) not being included [49,85] or not informed [81] in the process. This highlights the need to include patents in an informed decision process [34,87,91]; in terms of the use of decision aids [86] and where decision-making was a shared decision, it related to men from or in the military [54].…”

Prostate Cancer Screening Uptake in Transgender Women

“…Specific to transgender women, a Thai questionnaire study demonstrated that increased prostate cancer awareness among transgender women was associated with higher educational levels, knowledge that they retained their prostate after gender-affirming surgery, and education by the gender-affirming surgeon regarding the possibility of prostate cancer . Another study analyzing PSA screening rates using BRFSS data found these same trends persisted in underserved minority populations, as use of PSA screening increased with higher educational levels. Further, although PSA screening increased with increasing age in both transgender women and cisgender men, with those 70 years and older being recently screened at the highest frequency in transgender women (41.8%) and cisgender men (40.2%), relatively more cisgender men were screened within the recommended age range of 55 to 69 years (36.3% vs 22.2%).…”

Racial/ethnic disparities in the cause of death among patients with prostate cancer in the United States from 1995 to 2019: a population-based retrospective cohort study

“…Stage is itself influenced by a myriad of factors, which include socioeconomic status, cancer awareness, health insurance, uptake of prostate specific antigen (PSA) screening, access to health care, cultural attitudes towards screening, healthcare provider biases, and biological factors. 20 Lower PSA screening prevalence among AI/AN men and Black men than among white men likely contributes to the lower proportion of localised disease diagnosis, which subsequently contributes to racial/ethnic disparities in death among patients with prostate cancer. 21 , 22 In 2012, the US Preventive Services Taskforce (USPSTF) recommended against screening for prostate cancer in men of all ages.…”