Abstract B80: Racial differences in prostate cancer screening practices in U.S. ambulatory care settings prior to and following U.S. Preventive Services Task Force recommendations in 2008
Authors: Jayasekera Jinani , Onukwugha Eberechukwu 
Published: May 2015

Introduction: In May 2012, the United States Preventive Services Task Force (USPSTF) finalized its recommendation (rec.) against prostate-specific antigen (PSA) screening in all men in the general US population. The implications of the recommendations for PSA screening in African American (AA), Hispanic (H) and White (W) men will not be known for some time. However, the USPSTF's August 2008 rec. against PSA-based screening for men older than 75 years may inform expectations. The objective of this study was to investigate the impact of the 2008 USPSTF rec. on PSA screening practices during routine preventive health exams (PHE) among AA, H, and W men in ambulatory care settings.

Methods: We analyzed a nationally representative sample of visits to office-based physicians' practices from 2005 to 2010 using the National Ambulatory Medical Care Survey (NAMCS). The sample consisted of outpatient visits for PHEs of men over 40 years, without prostate cancer. PHEs were identified using, 1) patient's stated reason and physician-reported major reason for visit indicating a general medical exam or prevention, or 2) physician's recorded diagnosis for general medical exam. The study period was divided into pre-rec. (2005-07) and post-rec. (2008-10) periods. Information including PSA screening during the PHE, patient demographics, physician specialty and type of office setting was collected. Descriptive and bivariate analyses accounting for the NAMCS survey design provided the unadjusted relationships between PSA screening, race/ethnicity, period and age. Generalized estimating equations (GEE) were used to investigate the demographic patterns in the receipt of PSA screening during PHEs occurring around the time of the USPSTF rec.

Results: Application of the inclusion criteria resulted in 6,099 office visits for PHEs from 2005-10. Twenty percent (N=1,241) of the sample was aged ≤75 years, 76% (N=4,630) was W, 10% (N=591) AA and 9% (N=564) H. Overall, 16% received PSAs during a PHE in the pre-rec. period and 18% in the post-rec. period (p=0.14). The percentage of PSA screens received during a PHE in pre-rec. vs. post-rec. period was 13% vs. 16% (p=0.44) among AAs, 9% vs. 14% (p=0.13) among Hs, and 16% vs. 19% (p=0.12) among Ws. The percentage of W men, aged 40 to 75, receiving a PSA test during a PHE (20%) was statistically significantly higher than AAs (16%) and Hs (13%) (p= 0.03). Among those ≥75 years, there was no statistically significant difference in the receipt of PSA screening between AAs (11%), Hs (4%), and Ws (11%) (p=0.07). GEE analysis did not show a statistically significant difference in the covariate-adjusted odds of receiving a PSA screen during a PHE in the post-period compared to the pre-period (p=0.40) or among AAs compared to Ws (p=0.22). Odds of receiving a PSA screen were lower among patients aged ≥75 years compared to patients less than 75 years old (odds ratio=0.51, 95% CI=0.36-0.73; p&lt;0.01). Odds of receiving a PSA screen also were lower among Hs compared to Ws (OR=0.64, 95% CI=0.43-0.96; p=0.03). Odds of receiving a PSA screen were higher for visits to a urologist compared to visits to a general practitioner (OR=4.30, 95% CI=2.92-6.34; p&lt;0.01).

Conclusion: The probability of receiving a PSA screening during a PHE was unchanged during the period immediately prior to and following the 2008 USPSTF rec. against PSA screening for men 75 years and older. At the same time, men 75 years and older (compared to &lt;75 years) and H men (compared to W) were less likely to receive a PSA screening during a PHE. Analyses exploring the impact of the 2012 USPSTF recommendations against PSA screening for all men should consider the impact among race and age subgroups with lower baseline chances of receiving a PSA screen in ambulatory care settings.

Citation Format: Jinani Jayasekera, Eberechukwu Onukwugha. Racial differences in prostate cancer screening practices in U.S. ambulatory care settings prior to and following U.S. Preventive Services Task Force recommendations in 2008. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B80. doi:10.1158/1538-7755.DISP13-B80