Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
J Natl Cancer Inst. 2021 Jun 1;113(6):719-726. doi: 10.1093/jnci/djaa171.
The 2012 US Preventive Services Task Force recommendation against routine prostate-specific antigen (PSA) testing led to a decrease in prostate cancer screening, but the heterogeneity of its impact by race and ethnicity remains unclear.
The proportion of 40- to 74-year-old men who self-reported receiving a routine PSA test in the past year was estimated in the Behavioral Risk Factor Surveillance System (2012-2018). Odds ratios (ORs) of undergoing screening by race and ethnicity were estimated, adjusting for healthcare-related factors. Prostate cancer incidence rates and rate ratios (IRRs) by race and ethnicity were estimated using Surveillance, Epidemiology, and End Results registry data (2004-2017).
PSA testing frequencies were 32.3% (95% confidence interval [CI] = 31.7% to 32.8%) among non-Hispanic White (NHW), 30.3% (95% CI = 28.3% to 32.3%) among non-Hispanic Black (NHB), 21.8% (95% CI = 19.9% to 23.7%) among Hispanic, and 17.7% (95% CI = 14.1% to 21.3%) among Asian and Pacific Islander men in 2012. The absolute screening frequency declined by 9.5% from 2012 to 2018, with a larger decline among NHB (11.6%) than NHW men (9.3%). The relative annual decrease was greater among NHB (OR = 0.86, 95% CI = 0.84 to 0.88) than NHW men (OR = 0.89, 95% CI = 0.89 to 0.90; Pheterogeneity = .005), driven by a larger decline among NHB men ages 40-54 years. The NHB to NHW IRR for total prostate cancer increased from 1.73 (95% CI = 1.69 to 1.76) in 2011 to 1.87 (95% CI = 1.83 to 1.92) in 2012 and has remained elevated, driven by differences in localized tumor incidence. Metastatic disease incidence is rising across all racial and ethnic groups.
The frequency of prostate cancer screening varies by race and ethnicity, and there was a modestly steeper decline in PSA testing among younger NHB men relative to NHW men since 2012. The NHB to NHW IRR for localized prostate cancer modestly increased following 2012.
2012 年美国预防服务工作组建议反对常规前列腺特异性抗原（PSA）检测，导致前列腺癌筛查减少，但种族和民族之间其影响的异质性仍不清楚。
使用行为风险因素监测系统（2012-2018 年）估计 40-74 岁男性中自我报告过去一年接受常规 PSA 检测的比例。按医疗保健相关因素调整后，估计按种族和民族进行筛查的比值比（OR）。使用监测、流行病学和最终结果登记数据（2004-2017 年）估计按种族和民族划分的前列腺癌发病率和率比（IRR）。
2012 年，非西班牙裔白人（NHW）中 PSA 检测频率为 32.3%（95%置信区间[CI] = 31.7%至 32.8%），非西班牙裔黑人（NHB）中为 30.3%（95%CI = 28.3%至 32.3%），西班牙裔中为 21.8%（95%CI = 19.9%至 23.7%），亚裔和太平洋岛民中为 17.7%（95%CI = 14.1%至 21.3%）。2012 年至 2018 年，绝对筛查频率下降了 9.5%，NHB（11.6%）的降幅大于 NHW 男性（9.3%）。NHB 的相对年降幅大于 NHW 男性（OR=0.86，95%CI=0.84 至 0.88），差异有统计学意义（OR 异质性=0.005），这主要归因于 40-54 岁 NHB 男性降幅较大。2011 年，总前列腺癌的 NHB 与 NHW 的发病率比（IRR）为 1.73（95%CI=1.69 至 1.76），2012 年增至 1.87（95%CI=1.83 至 1.92），并一直保持高位，这主要归因于局部肿瘤发病率的差异。自 2012 年以来，所有种族和民族的转移性疾病发病率都在上升。
前列腺癌筛查的频率因种族和民族而异，自 2012 年以来，年轻的 NHB 男性相对于 NHW 男性，PSA 检测的下降幅度略大。2012 年后，NHB 与 NHW 之间局部前列腺癌的发病率比（IRR）略有增加。
