Ross Louie E, Richardson Lisa C, Berkowitz Zahava
Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
J Natl Med Assoc. 2006 Nov;98(11):1823-9.
Many medical and professional organizations agree that men should discuss the advantages and disadvantages of testing for prostate-specific antigen (PSA) with their physicians before undergoing testing. In the 2000 National Health Interview Survey, men who had undergone a PSA test in the past were asked about their use of this test and discussions they had with physicians regarding its advantages and disadvantages. Among a group of 2,188 black and white men aged 40-79 years with no history of prostate cancer and a history of testing for PSA, we examined whether physician-patient discussions mediated the relationship between race and PSA testing. We specified that the test had to be their most recent one and part of a routine physical examination or screening test. We compared those tested within the past two years with those tested >2 years. Almost two-thirds of the men previously had discussions with their physicians about the advantages and disadvantages of the PSA test. Older men, college graduates, those living in the midwest and those with health insurance were more likely to have been tested recently. Discussion with a physician was found to mediate the relationship between race and PSA testing during the past two years. Black men were initially found to be more likely than white men to have been screened recently [odds ratio (OR)=1.45; 95% confidence interval (CI) 1.01-2.07], but in the full model race was no longer significant (OR=1.41; 95% Cl 0.98-2.03). Discussions about PSA testing were associated with more recent PSA screening (OR=1.38, 95% CI 1.05-1.82). These findings suggest that: 1) the relationships among race, physician discussions and PSA testing may need to be examined in more complex ways, and 2) the physician has an important role in men's decision to consider PSA testing.
许多医学和专业组织都认为，男性在进行前列腺特异性抗原（PSA）检测之前，应与医生讨论检测的利弊。在2000年全国健康访谈调查中，曾接受过PSA检测的男性被问及他们对该检测的使用情况以及与医生就其利弊进行的讨论。在一组2188名年龄在40 - 79岁之间、无前列腺癌病史且有PSA检测史的黑人和白人男性中，我们研究了医患讨论是否介导了种族与PSA检测之间的关系。我们规定该检测必须是他们最近的一次检测，并且是常规体检或筛查检测的一部分。我们将过去两年内接受检测的男性与检测时间超过两年的男性进行了比较。近三分之二的男性此前曾与医生讨论过PSA检测的利弊。年龄较大的男性、大学毕业生、居住在中西部的男性以及有医疗保险的男性近期接受检测的可能性更大。研究发现，在过去两年中，与医生的讨论介导了种族与PSA检测之间的关系。最初发现黑人男性近期接受筛查的可能性比白人男性更大[优势比（OR）=1.45；95%置信区间（CI）1.01 - 2.07]，但在完整模型中，种族不再具有统计学意义（OR = 1.41；95% CI 0.98 - 2.03）。关于PSA检测的讨论与近期的PSA筛查相关（OR = 1.38，95% CI 1.05 - 1.82）。这些发现表明：1）种族与医生讨论以及PSA检测之间的关系可能需要以更复杂的方式进行研究；2）医生在男性考虑进行PSA检测的决策中起着重要作用。
