Abstract C016: Racial differences in the incidence of fatal prostate cancer in two countries: An ecological comparison of the United States and England
Authors: Butler Eboneé N. , Kelly Scott P. , Coupland Victoria H. , Rosenberg Philip R. , Cook Michael B. 
Published: August 2020

Abstract
Background: Differential uptake of prostate-specific antigen (PSA) testing in the US and UK has been linked to between-country differences in prostate cancer incidence. In the US, men of African ancestry have been shown to have a higher incidence of prostate cancer that is ultimately fatal compared with men of European ancestry, thus prompting calls for precision prevention approaches to screening. To assess whether temporal and racial differences are evident in the UK, we assessed the incidence of fatal prostate cancer in the US and England during a period of evolving screening recommendations and practices in both countries.
Methods: Using data from the Surveillance, Epidemiology, and End Results program and Public Health England's National Cancer Registration and Analysis Service, we identified prostate cancer patients newly diagnosed between 1995 and 2005, aged 45-84 years old. We defined fatal prostate cancer as death attributed to the disease within 10 years of diagnosis. To evaluate incidence trends across the 11-year study period, we used age-period-cohort modeling to calculate estimated annual percentage change (EAPC) and joinpoint regression analysis to identify periods of significant change.
Results: In the US, 9% (n=38,409) of the 429,541 prostate cancer cases were fatal, compared with 17% (n=39,249) of the 228,615 cases in England. The age-adjusted incidence of fatal prostate cancer declined in the US by -4.2% per year (95%CI: -4.6%, -3.8%) and increased in England by 7.7% per year (95%CI:7.2%, 8.3%). From 2002-2005, the US experienced a more rapid decline in the incidence of fatal disease (EAPC = -6.4%; 95%CI: -8.3%, -4.5%) while rates in England continued to increase, albeit to a lesser degree (EAPC = 4.3%; 95%CI: -0.1%, 8.9%). Temporal trends for each country did not differ by race. However, a black-to-white difference persisted across the study period, with black men in both the US and England experiencing 2-to-3-fold higher incidence rates of fatal prostate cancer compared with white men.
Conclusions: During a period of increased PSA testing in the US and relatively low, but growing, use in England, we observed opposing trends for the incidence of fatal prostate cancer between the two countries. Our ecological study suggests that country-specific screening practices may influence temporal trends for the incidence of fatal prostate cancer similarly for black and white men, though a disparity persists in the absolute rate of disease occurrence between the two groups.
Citation Format: Eboneé N. Butler, Scott P. Kelly, Victoria H. Coupland, Philip R. Rosenberg, Michael B. Cook. Racial differences in the incidence of fatal prostate cancer in two countries: An ecological comparison of the United States and England [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C016.