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- Title
The Impact of Intensifying Prostate Cancer Screening in Black Men: A Model-Based Analysis.
- Authors
Nyame, Yaw A; Gulati, Roman; Heijnsdijk, Eveline A M; Tsodikov, Alex; Mariotto, Angela B; Gore, John L; Etzioni, Ruth
- Abstract
<bold>Background: </bold>Black men in the United States have markedly higher rates of prostate cancer than the general population. National guidelines for prostate-specific antigen (PSA) screening do not provide clear guidance for this high-risk population. The purpose of this study is to estimate the benefit and harm of intensified PSA screening in Black men.<bold>Methods: </bold>Two microsimulation models of prostate cancer calibrated to incidence from the Surveillance, Epidemiology, and End Results program among Black men project the impact of different screening strategies (varying screening intervals, starting and stopping ages, and biopsy utilization following an abnormal PSA) on disease-specific mortality and overdiagnosis. Each strategy induces a mean lead time (MLT) for detected cases. A longer MLT reduces mortality according to estimates combining the US and European prostate cancer screening trials but increases overdiagnosis.<bold>Results: </bold>Under historical population screening, Black men had similar MLT to men of all races and similar mortality reduction (range between models = 21%-24% vs 20%-24%) but a higher frequency of overdiagnosis (75-86 vs 58-60 per 1000 men). Screening Black men aged 40-84 years annually would increase both mortality reduction (29%-31%) and overdiagnosis (112-129 per 1000). Restricting screening to ages 45-69 years would still achieve substantial mortality reduction (26%-29%) with lower overdiagnosis (51-61 per 1000). Increasing biopsy utilization to 100% of abnormal tests would further reduce mortality but substantially increase overdiagnosis.<bold>Conclusions: </bold>Annual screening in Black men is expected to reduce mortality more than that estimated under historical screening. Limiting screening to men younger than 70 years is expected to help reduce overdiagnosis.
- Subjects
UNITED States; PROSTATE cancer; BLACK men; EARLY detection of cancer; OLDER men; PROSTATE-specific antigen; LEAD time (Supply chain management); RESEARCH; BIOPSY; RESEARCH methodology; MEDICAL screening; EVALUATION research; COMPARATIVE studies; PROSTATE tumors
- Publication
JNCI: Journal of the National Cancer Institute, 2021, Vol 113, Issue 10, p1336
- ISSN
0027-8874
- Publication type
journal article
- DOI
10.1093/jnci/djab072