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Author: R. David McNally
Publisher:
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Category :
Languages : en
Pages :
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Prostate cancer is the most commonly diagnosed cancer among men in the United States. It is frequently cited that racial disparities in mortality between Caucasian and African American men with localized prostate cancer exist. In addition, the question of whether prostate cancer screening with the prostate specific antigen blood test (PSA) leads to reduced mortality remains unanswered. Outcomes theory and survival analysis have shown controversial inconsistencies in support of early detection methods for prostate cancer to the extent that experts in the medical community do not agree on best-practice guidelines suggestive of eliminating such disparities and reducing mortality. The purpose of this study was to explore the relationship between screening PSA tests and racial differences in mortality among Caucasian and African American men with application of a propensity scoring analysis on a large population-based data set. Prostate cancer patients diagnosed from January 1, 1986 through December 31, 2006 (n = 515,802 cases) from the SEER-17 data set linked to Medicare claims files were included. A separate analysis using a 5% randomized group of over 263,000 men without prostate cancer was also examined. The results demonstrated that no statistically significant differences in mortality between Caucasians and African Americans in the prostate cancer group existed (p=0.993). Further, the same result was found among men from the 5% randomized group without prostate cancer (p= 0.832), that no statistically significant difference exists for this study population when using a propensity scoring analysis and a conditional Cox regression model. From both analyses, no survival benefit was found for screened men versus non-screened men when using the PSA test for early detection. In addition, because age is a well-known predictor of death, a separate analysis was performed on age-matched men. The results for the age analysis also demonstrated no statistically significant differences in racial mortality or whether screening PSA reduced mortality after applying a propensity scoring analysis to a conditional Cox regression model. In conclusion, it is believed that using a propensity scoring method and Cox regression analysis improved the evaluation of this large population data set where censoring for survival time was important and where matched pairs were utilized. Further work in health services research using large population-based data sets should be pursued and incorporating Cox regression with a propensity analysis can be helpful.
Author: R. David McNally
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Book Description
Prostate cancer is the most commonly diagnosed cancer among men in the United States. It is frequently cited that racial disparities in mortality between Caucasian and African American men with localized prostate cancer exist. In addition, the question of whether prostate cancer screening with the prostate specific antigen blood test (PSA) leads to reduced mortality remains unanswered. Outcomes theory and survival analysis have shown controversial inconsistencies in support of early detection methods for prostate cancer to the extent that experts in the medical community do not agree on best-practice guidelines suggestive of eliminating such disparities and reducing mortality. The purpose of this study was to explore the relationship between screening PSA tests and racial differences in mortality among Caucasian and African American men with application of a propensity scoring analysis on a large population-based data set. Prostate cancer patients diagnosed from January 1, 1986 through December 31, 2006 (n = 515,802 cases) from the SEER-17 data set linked to Medicare claims files were included. A separate analysis using a 5% randomized group of over 263,000 men without prostate cancer was also examined. The results demonstrated that no statistically significant differences in mortality between Caucasians and African Americans in the prostate cancer group existed (p=0.993). Further, the same result was found among men from the 5% randomized group without prostate cancer (p= 0.832), that no statistically significant difference exists for this study population when using a propensity scoring analysis and a conditional Cox regression model. From both analyses, no survival benefit was found for screened men versus non-screened men when using the PSA test for early detection. In addition, because age is a well-known predictor of death, a separate analysis was performed on age-matched men. The results for the age analysis also demonstrated no statistically significant differences in racial mortality or whether screening PSA reduced mortality after applying a propensity scoring analysis to a conditional Cox regression model. In conclusion, it is believed that using a propensity scoring method and Cox regression analysis improved the evaluation of this large population data set where censoring for survival time was important and where matched pairs were utilized. Further work in health services research using large population-based data sets should be pursued and incorporating Cox regression with a propensity analysis can be helpful.
Author: Benjamin Sener Dunlap
Publisher:
ISBN:
Category :
Languages : en
Pages : 22
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Background: Most major U.S. medical organizations recommend that screening for prostate cancer using the prostate-specific antigen (PSA) test should be based on individual patient preferences. Men with risk factors for prostate cancer diagnosis and mortality may have different preferences for screening than men without any risk factors. Methods: We used nationally-representative survey data from the 2005 and 2010 National Health Interview Survey to assess PSA-screening patterns by age, family history of prostate cancer and race among men in the United States over 40 years old using bivariate and multivariable logistic regression. Results: Men with any family history of prostate cancer were more likely to be screened using the PSA test in the last two years at any age (OR=2.2, 95% CI 1.8-2.6), and men with a father and brother diagnosed were more likely to be screened than men with only a father diagnosed, after adjustment (p=0.019). Younger (40-54 year old) African-American or black men had a higher odds of being screened than White, non-Hispanic men of the same age, after adjustment (OR=1.5, 95% CI=1.2-1.9), but this same adjusted comparison within other age groups indicated no significant difference in screening rates by race (age 55-69 years old: OR=1.0, 95% CI=0.8-1.3; age 70 years or more: OR=-0.9, 95% CI=0.7-1.3). Conclusion: There is considerable heterogeneity in PSA-screening practices. A family history of prostate cancer, and to a limited degree black or African-American race, both contribute to increased odds of undergoing screening. Understanding how to discuss risk factors with men to ensure individual patient preferences are appropriately integrated into screening decisions should be a priority for providers.
Author: Kenneth Lin
Publisher:
ISBN:
Category :
Languages : en
Pages :
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BACKGROUND: Prostate cancer is the most common nonskin cancer in men in the United States, and prostate cancer screening has increased in recent years. In 2002, the U.S. Preventive Services Task Force concluded that evidence was insufficient to recommend for or against screening for prostate cancer with prostate-specific antigen (PSA) testing. PURPOSE: To examine new evidence of benefits and harms of screening asymptomatic men for prostate cancer with PSA testing. DATA SOURCES: English-language articles identified in PubMed and the Cochrane Library (search dates, January 2002 to July 2007), reference lists of retrieved articles, and expert suggestions. STUDY SELECTION: Randomized, controlled trials and meta-analyses of PSA screening and cross-sectional and cohort studies of screening harms and of the natural history of screening-detected cancer were selected to answer the following questions: Does screening for prostate cancer with PSA, as a single-threshold test or as a function of multiple tests over time, decrease morbidity or mortality? What are the magnitude and nature of harms associated with prostate cancer screening, other than overtreatment? What is the natural history of PSA-detected, nonpalpable, localized prostate cancer? DATA EXTRACTION: Studies were reviewed, abstracted, and rated for quality by using predefined U.S. Preventive Services Task Force criteria. DATA SYNTHESIS: No good-quality randomized, controlled trials of screening for prostate cancer have been completed. In 1 cross-sectional and 2 prospective cohort studies of fair to good quality, false-positive PSA screening results caused psychological adverse effects for up to 1 year after the test. The natural history of PSA-detected prostate cancer is poorly understood. LIMITATIONS: Few eligible studies were identified. Long-term adverse effects of false-positive PSA screening test results are unknown. CONCLUSION: Prostate-specific antigen screening is associated with psychological harms, and its potential benefits remain uncertain. Prostate cancer is the most common nonskin cancer in U.S. men. An estimated 218,890 men received a new diagnosis of prostate cancer in 2007, and 1 in 6 men will receive a diagnosis in their lifetime. The American Cancer Society estimates that 27,350 men died of prostate cancer in 2006. After peaking in 1991 (29.4 deaths per 100,000 men), the prostate cancer mortality rate has gradually decreased. Although this positive trend may be related to increased screening for prostate cancer, other factors, including new treatment approaches, could also account for some or all of the observed decline in mortality. The serum prostate-specific antigen (PSA) test was approved by the U.S. Food and Drug Administration in 1986, and its use for prostate cancer screening has increased substantially since the mid-1990s. However, PSA testing is not specific to prostate cancer; common conditions, such as benign prostatic hyperplasia and prostatitis, also increase PSA levels. Approximately 1.5 million U.S. men age 40 to 69 years have a PSA level greater than 4.0 ơg/L, a widely used cutoff value for a positive screening result. Refinements designed to improve the PSA test's sensitivity and specificity for prostate cancer include determination of PSA density, PSA velocity, PSA doubling time, and percentage of free PSA. Potential harms from PSA screening include additional medical visits, adverse effects of prostate biopsies, anxiety, and overdiagnosis (the identification of prostate cancer that would never have caused symptoms in the patient's lifetime, leading to unnecessary treatment and associated adverse effects). Much uncertainty surrounds which cases of prostate cancer require treatment and whether earlier detection leads to improvements in duration or quality of life. Two recent systematic reviews of the comparative effectiveness and harms of therapies for localized prostate cancer concluded that no single therapy is superior to all others in all situations. In 2002, the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to recommend for or against routine screening for prostate cancer. The USPSTF found good evidence that PSA screening can detect early-stage prostate cancer but found mixed and inconclusive evidence that screening and early detection improve health outcomes. Consequently, the USPSTF was unable to determine the balance between benefits and harms of periodic screening for prostate cancer. The analytic framework that guided the previous USPSTF evidence review (Figure) included 8 key questions about benefits and harms of prostate cancer screening and treatment. This evidence update focuses on critical gaps in the evidence that the Task Force identified in the previous review: the lack of good-quality studies linking screening to improved health outcomes; limited information about harms of screening; and a paucity of knowledge about the natural history of PSA-detected, nonpalpable, localized prostate cancer (the most common type of prostate cancer detected today). These evidence gaps produced 3 new key questions for this update: 1. Does screening for prostate cancer with PSA, as a single-threshold test or as a function of multiple tests over time, decrease morbidity or mortality? 2. What are the magnitude and nature of harms associated with prostate cancer screening other than overtreatment? 3. What is the natural history of PSA-detected, nonpalpable, localized prostate cancer?
Author:
Publisher:
ISBN:
Category :
Languages : en
Pages : 56
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BACKGROUND: In 2008, the U.S. Preventive Services Task Force (USPSTF) concluded that the evidence was insufficient to assess the balance of benefits and harms of screening for prostate cancer in men younger than age 75 years. The USPSTF recommended against screening for prostate cancer in men aged 75 years or older. PURPOSE: To update a previous systematic review performed for the USPSTF and evaluate new evidence on the potential benefits of prostate-specific antigen (PSA)-based screening for prostate cancer. DATA SOURCES: English-language articles identified in PubMed and the Cochrane Library (search dates January 2007 to July 2011), reference lists of retrieved articles, and expert suggestions. STUDY SELECTION: Randomized controlled trials, systematic reviews, and meta-analyses were selected to determine whether PSA-based screening decreases prostate cancer-specific or all-cause mortality. Where available, information on the potential harms of screening for prostate cancer was also extracted from included studies. DATA EXTRACTION: Studies were reviewed, abstracted, and rated for quality, using predefined USPSTF criteria. DATA SYNTHESIS: Five randomized controlled trials (two fair- and three poor-quality) and two meta-analyses evaluating the impact of PSA-based screening on prostate cancer mortality were identified. A report describing results from a single center participating in one of the fair-quality trials was also identified. Of the two highest-quality trials, the U.S. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial found no statistically significant effect of PSA-based screening on prostate cancer mortality after 10 years (rate ratio [RR], 1.11 [95% CI, 0.83-1.50]). The European Randomized Study of Screening for Prostate Cancer also found no statistically significant effect in all enrolled men (ages 50-74 years) after a median followup of 9 years (RR, 0.85 [95% CI, 0.73-1.00]), but reported a 0.07% absolute risk reduction in a prespecified subgroup of men aged 55 to 69 years (RR, 0.80 [95% CI, 0.65-0.98]). Neither meta-analysis indicated a reduction in prostate cancer mortality with the use of PSA-based screening. When a benefit was found, PSA-based screening resulted in an estimated 48 additional men being treated for each prostate cancer death that was averted. Twelve percent to 13% of screened men had false-positive results after 3 to 4 screening rounds, and clinically important infections, bleeding, or urinary retention occurred after 0.5%-1.0% of prostate biopsies. LIMITATIONS: Evidence was conflicting regarding the effect of screening on prostate cancer mortality in the highest-quality trials; they also represented interim results. We restricted the search on the potential harms of PSA-based screening to information available from randomized efficacy trials. CONCLUSIONS: After about 10 years, PSA-based screening results in the detection of more cases of prostate cancer, but small to no reduction in prostate cancer-specific mortality.
Author: Andrew W. Bruce
Publisher: Springer Science & Business Media
ISBN: 1447113985
Category : Medical
Languages : en
Pages : 363
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Book Description
Carcinoma of the prostate increasingly dominates the attention of urologists for both scientific and clinical reasons. The search for an explanation and the prediction of the variable behaviour of the malignant prostatic cell continues unabated. The search for more precise tumour staging and more effective treatment is equally vigorous. Editors Andrew Bruce and John Trachtenberg have assembled acknowledged leaders in prostate cancer to present those areas of direct interest to the clinician. There are a number of other topics that might have been considered but most of these, such as experimental tumour models or biochemical factors affecting cell growth, still lack immediate application for the clinician. Carcinoma of the prostate continues to have its highest incidence in the western world, and the difference in comparison with the incidence in the Far East appears to be real and not masked by diagnostic or other factors. A number of other epidemiological aspects need careful analysis: Is the incidence increasing? Is the survival improving? Is the prognosis worse in the younger patient? Epidemiological data are easily misused and misinterpreted so that a precise analysis of the known facts makes an important opening chapter to this book.
Author: David Alberts
Publisher: Springer Science & Business Media
ISBN: 3540689869
Category : Medical
Languages : en
Pages : 542
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Book Description
An authoritative work that provides a detailed review of the current status of cancer prevention and control practice and research. This volume is an essential reference guide and tool for primary care physicians, the research community and students. Written as a collaborative work by the faculty of the nationally renowned Cancer Prevention and Control Program at the Arizona Cancer Center, this book brings together the expertise of specialists in the field of cancer prevention and control to provide the medical and research community that does not specialize in this field with insight to the disciplines of cancer prevention and control.
Author: Amelie G. Ramirez
Publisher: Springer Nature
ISBN: 303029286X
Category : Medical
Languages : en
Pages : 320
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Book Description
This open access book gives an overview of the sessions, panel discussions, and outcomes of the Advancing the Science of Cancer in Latinos conference, held in February 2018 in San Antonio, Texas, USA, and hosted by the Mays Cancer Center and the Institute for Health Promotion Research at UT Health San Antonio. Latinos – the largest, youngest, and fastest-growing minority group in the United States – are expected to face a 142% rise in cancer cases in coming years. Although there has been substantial advancement in cancer prevention, screening, diagnosis, and treatment over the past few decades, addressing Latino cancer health disparities has not nearly kept pace with progress. The diverse and dynamic group of speakers and panelists brought together at the Advancing the Science of Cancer in Latinos conference provided in-depth insights as well as progress and actionable goals for Latino-focused basic science research, clinical best practices, community interventions, and what can be done by way of prevention, screening, diagnosis, and treatment of cancer in Latinos. These insights have been translated into the chapters included in this compendium; the chapters summarize the presentations and include current knowledge in the specific topic areas, identified gaps, and top priority areas for future cancer research in Latinos. Topics included among the chapters: Colorectal cancer disparities in Latinos: Genes vs. Environment Breast cancer risk and mortality in women of Latin American origin Differential cancer risk in Latinos: The role of diet Overcoming barriers for Latinos on cancer clinical trials Es tiempo: Engaging Latinas in cervical cancer research Emerging policies in U.S. health care Advancing the Science of Cancer in Latinos proves to be an indispensable resource offering key insights into actionable targets for basic science research, suggestions for clinical best practices and community interventions, and novel strategies and advocacy opportunities to reduce health disparities in Latino communities. It will find an engaged audience among researchers, academics, physicians and other healthcare professionals, patient advocates, students, and others with an interest in the broad field of Latino cancer.
Author: SEER Program (National Cancer Institute (U.S.))
Publisher:
ISBN:
Category : Cancer
Languages : en
Pages : 104
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Author: Martin I. Resnick
Publisher:
ISBN:
Category : Medical
Languages : en
Pages : 200
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Focusing on the diagnosis of prostate disorders via ultrasound, this work discusses recent advances and techniques, such as transrectal views. Coverage includes prostate cancer, prostate and ultrasound anatomy, benign hyperplasia, inflammatory disease and calculi and male infertility.
Author: H. Gilbert Welch
Publisher: Univ of California Press
ISBN: 0520248368
Category : Family & Relationships
Languages : en
Pages : 240
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Book Description
In this thought-provoking volume, a physician and public health expert challenges the notion that detecting cancer early always saves lives.
