Delfino R J, Ferrini R L, Taylor T H, Howe S, Anton-Culver H
Department of Medicine, University of California, College of Medicine, Irvine 92697-7550, USA.
Am J Prev Med. 1998 Feb;14(2):96-102. doi: 10.1016/s0749-3797(97)00014-7.
Geographic and racial/ethnic variability in prostate cancer incidence rates and stage distribution may be partly attributed to differences in screening and early detection.
Using California Cancer Registry data we aimed to characterize variability in prostate cancer rates statewide and to examine differences in the stage at diagnosis of prostate cancer by racial/ethnic group statewide and by census tract per capita income in San Diego County. We calculated annual average (1988-1991) age-adjusted incidence rates per 100,000 (AAIR) of prostate cancer for 49,880 men over age 34 years. Racial/ethnic groups were compared using incidence rate ratios (IRR) (AAIR localized plus regional stages divided by AAIR distant stage).
Statewide, Caucasians showed a higher IRR [6.16, 95% confidence interval (CI), 6.00-6.30] than did African Americans (2.34, 95% CI, 1.89-2.89), Hispanics (3.84, 95% CI, 3.63-4.05), or Asian/others (3.61, 95% CI, 1.80-7.22). Within San Diego County, Caucasians living in higher per capita income census tracts (> or = 65th percentile) had a significantly higher IRR (8.80, 95% CI 7.84-9.89) than did lower-income tracts (5.68, 95% CI, 5.13-6.30).
Findings from the present and similar studies suggest that outcomes research is needed to determine the impact of these demographic differences on prostate cancer mortality and quality of life. This is particularly important given the current controversy regarding the treatment of clinically localized prostate cancers, increasingly found through early detection, which often involve difficult choices between aggressive therapies including prostatectomy or watchful waiting.
前列腺癌发病率和分期分布的地理及种族/族裔差异可能部分归因于筛查和早期检测的差异。
利用加利福尼亚癌症登记处的数据，我们旨在描述全州前列腺癌发病率的差异，并按全州种族/族裔群体以及圣地亚哥县按人均收入的普查区来检查前列腺癌诊断分期的差异。我们计算了49880名34岁以上男性每10万人中前列腺癌的年平均（1988 - 1991年）年龄调整发病率（AAIR）。使用发病率比（IRR）（局限性加区域性分期的AAIR除以远处分期的AAIR）对种族/族裔群体进行比较。
在全州范围内，白种人的IRR[6.16，95%置信区间（CI），6.00 - 6.30]高于非裔美国人（2.34，95% CI，1.89 - 2.89）、西班牙裔（3.84，95% CI，3.63 - 4.05）或亚裔/其他族裔（3.61，95% CI，1.80 - 7.22）。在圣地亚哥县内，居住在人均收入较高普查区（≥第65百分位数）的白种人的IRR（8.80，95% CI 7.84 - 9.89）显著高于低收入普查区（5.68，95% CI，5.13 - 6.30）。
本研究及类似研究的结果表明，需要进行结果研究以确定这些人口统计学差异对前列腺癌死亡率和生活质量的影响。鉴于目前关于临床局限性前列腺癌治疗的争议，这一点尤为重要，临床局限性前列腺癌通过早期检测越来越多地被发现，这常常涉及在包括前列腺切除术或观察等待在内的积极治疗之间做出艰难选择。
