Racial Disparities in Prostate Cancer: Evaluation of Diet, Lifestyle, Family History, and Screening Patterns

Hansen, Megan; Hamieh, Nadine; Markt, Sarah C.; Vaselkiv, Jane B.; Pernar, Claire H.; Gonzalez‐Feliciano, Amparo G.; Peisch, Samuel; Chowdhury-Paulino, Ilkania M.; Rencsok, Emily M; Rebbeck, Timothy R.; Platz, Elizabeth A.; Giovannucci, Edward; Wilson, Kathryn M.; Mucci, Lorelei A.

doi:10.1158/1055-9965.epi-21-1064

Cited by 11 publications

(6 citation statements)

References 37 publications

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“…Numerous studies ( 20 ) have underscored the association between ethnicity and prostate cancer risk on a global scale. Ranasinghe and colleagues ( 21 ) made an observation in England, revealing that despite equitable access to medical care, the incidence of prostate cancer among South Asian descendants remains substantially lower, at 49.5 cases per 100,000 person-years, compared with native whites.…”

Section: Discussionmentioning

confidence: 99%

Trends of Prostate Cancer Morbidity in Low-Incidence Countries from 1990–2019

Jiang,

Chen,

Tang

et al. 2024

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Our study was designed to elucidate the morbidity trends of prostate cancer in low-incidence countries. Methods: Data on prostate cancer were extracted from the 2019 Global Burden of Disease study. A cluster analysis of growth rates stratified by age was conducted, and correlation analyses were performed between age-standardized incidence rates (ASIR), estimated annual percent change (EAPC), and socio-demographic index (SDI). Results: Among 35 low-incidence countries for prostate cancer, predominantly located in Asia and North Africa, the SDI ranged from low to high-middle levels. Higher SDI regions exhibited considerably higher ASIR. With the exception of Kyrgyzstan, Kiribati, and Samoa that experienced a decrease in ASIR, the remaining 32 countries displayed an upward morbidity trend since 1990, with all their EAPCs exceeding the global average. In addition, men ages 90 years and above consistently exhibited the highest ASIR for prostate cancer. The most notable growth rate of ASIR was observed in individuals ages 20 to 44 years. Conclusions: Overall, low-incidence countries generally witnessed an increase in prostate cancer morbidity, albeit at levels lower than those seen in Western countries. Individuals ages 90 years and above consistently maintained the highest ASIR since 1990. Notably, more substantial increase of ASIR in younger age was also observed in low-incidence countries. Impact: This study offers a comprehensive overview of prostate cancer morbidity in low-incidence countries worldwide from 1990 to 2019. Future research should delve into the associations between incidence, clinical stages, PSA screening, environmental factors, lifestyle, and genetic risk in these low-incidence countries.

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Section: Discussionmentioning

confidence: 99%

Trends of Prostate Cancer Morbidity in Low-Incidence Countries from 1990–2019

Jiang,

Chen,

Tang

et al. 2024

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Section: Discussionmentioning

confidence: 99%

“…The 2 cohort studies included in this analysis were similar in both design and follow-up, but some differences should be noted. PSA testing was not available at study entry for men in the MDCS and in Sweden in general, whereas the uptake of PSA testing was quicker in the US and among men in the HPFS in particular . While the MDCS is population-based, the HPFS includes health professionals who generally have more favorable lifestyle characteristics compared with the broader US population .…”

Section: Discussionmentioning

confidence: 99%

“…PSA testing was not available at study entry for men in the MDCS and in Sweden in general, 33 whereas the uptake of PSA testing was quicker in the US and among men in the HPFS in particular. 34 While the MDCS is population-based, the HPFS includes health professionals who generally have more favorable lifestyle characteristics compared with the broader US population. 35 A higher proportion of men with unhealthy lifestyles may increase the percentage of preventable deaths, as illustrated in a previous study 35 estimating that adherence to a healthy lifestyle could have prevented 21% of overall prostate cancer deaths in the full HPFS cohort, and 40% of prostate cancer deaths in the broader US population.…”

Section: Discussionmentioning

confidence: 99%

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Early Prostate Cancer Deaths Among Men With Higher vs Lower Genetic Risk

Plym,

Zhang,

Stopsack

et al. 2024

JAMA Netw Open

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ImportanceProstate cancer, a leading cause of cancer death among men, urgently requires new prevention strategies, which may involve targeting men with an underlying genetic susceptibility.ObjectiveTo explore differences in risk of early prostate cancer death among men with higher vs lower genetic risk to inform prevention efforts.Design, Setting, and ParticipantsThis cohort study used a combined analysis of genotyped men without prostate cancer at inclusion and with lifestyle data in 2 prospective cohort studies in Sweden and the US, the Malmö Diet and Cancer Study (MDCS) and the Health Professionals Follow-Up Study (HPFS), followed up from 1991 to 2019. Data were analyzed between April 2023 and April 2024.ExposuresMen were categorized according to modifiable lifestyle behaviors and genetic risk. A polygenic risk score above the median or a family history of cancer defined men at higher genetic risk (67% of the study population); the remaining men were categorized as being at lower genetic risk.Main Outcomes and MeasuresProstate cancer death analyzed using time-to-event analysis estimating hazard ratios (HR), absolute risks, and preventable deaths by age.ResultsAmong the 19 607 men included for analysis, the median (IQR) age at inclusion was 59.0 (53.0-64.7) years (MDCS) and 65.1 (58.0-71.8) years (HPFS). During follow-up, 107 early (by age 75 years) and 337 late (after age 75 years) prostate cancer deaths were observed. Compared with men at lower genetic risk, men at higher genetic risk had increased rates of both early (HR, 3.26; 95% CI, 1.82-5.84) and late (HR, 2.26; 95% CI, 1.70-3.01) prostate cancer death, and higher lifetime risks of prostate cancer death (3.1% vs 1.3% [MDCS] and 2.3% vs 0.6% [HPFS]). Men at higher genetic risk accounted for 94 of 107 early prostate cancer deaths (88%), of which 36% (95% CI, 12%-60%) were estimated to be preventable through adherence to behaviors associated with a healthy lifestyle (not smoking, healthy weight, high physical activity, and a healthy diet).Conclusions and RelevanceIn this 20-year follow-up study, men with a genetic predisposition accounted for the vast majority of early prostate cancer deaths, of which one-third were estimated to be preventable. This suggests that men at increased genetic risk should be targeted in prostate cancer prevention strategies.

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“…The development of new screening tests has historically increased racial disparities for cancer outcomes, at least initially ( 10 ). Though racial disparities in screening narrow as new screening tests become more widely implemented, they still persist, for example, for prostate, colorectal, and breast cancer, which are the cancers with the highest incidence and mortality aside from LC ( 2 , 11 - 15 ). People belonging to racial and ethnic minority groups are less likely to be screened for these cancers though they often have higher incidence and mortality rates than White people.…”

Section: Discussionmentioning

confidence: 99%

Assessing how lung cancer screening guidelines contribute to racial disparities in screening access

Ivic-Pavlicic,

Joshi,

Zegarelli

et al. 2023

Transl Lung Cancer Res

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Background Lung cancer (LC) is the leading cause of cancer-related deaths in the United States (U.S.), with non-White people who smoke often bearing the burden of the highest rate of LC mortality. This is often due to later stage diagnoses, leading to poor prognosis and outcomes. We assess here how the eligibility criteria for LC screening set by the U.S. Preventive Services Task Force (USPSTF) and the Centers for Medicare and Medicaid Services (CMS) could contribute to racial disparities in screening access. Methods This paper analyzes data from the National Health and Nutrition Examination Survey (NHANES), an annual survey conducted by the Centers for Disease Control and Prevention (CDC) that gathers health and nutrition data from a representative sample of the U.S. population. After excluding those who were ineligible for LC screening, the final cohort of participants was 5,001, which consisted of 2,669 people who formerly smoked and 2,332 people who currently smoke. Results Out of 608 participants who were eligible for LC screening, 77.5% were non-Hispanic White (NHW) and 8.7% were non-Hispanic Black (NHB) participants versus 69.4% and 10.8% among 4,393 ineligible participants. Age, pack-years, and age along with pack-years were the most frequent reasons for ineligibility. LC screening ineligible NHW participants were statistically significantly older and had higher mean pack-years than the other racial and ethnic groups. NHB participants among the ineligible group had higher urinary cotinine levels compared to NHW participants. Conclusions This paper underscores the need for more individualized risk estimates when determining eligibility for LC screening, which could include biomarkers of smoking exposure. The analysis shows that current screening criteria, which rely solely on factors such as age and pack years, contribute to LC racial disparities.

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Racial Disparities in Prostate Cancer: Evaluation of Diet, Lifestyle, Family History, and Screening Patterns

Cited by 11 publications

References 37 publications

Trends of Prostate Cancer Morbidity in Low-Incidence Countries from 1990–2019

Trends of Prostate Cancer Morbidity in Low-Incidence Countries from 1990–2019

Early Prostate Cancer Deaths Among Men With Higher vs Lower Genetic Risk

Assessing how lung cancer screening guidelines contribute to racial disparities in screening access

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