Abstract 1818: Space-time analysis of racial disparities in advanced-stage prostate cancer incidence across Florida

Abstract

Abstract Prostate cancer is the most frequently diagnosed non-skin cancer and the second leading cause of cancer-related death for American men. Florida ranks second behind California for both incidence and mortality from prostate cancer in 2008. With the wide spread use of prostate specific antigen (PSA) and digital rectal examination (DRE), a larger proportion of prostate cancer cases is now diagnosed at early stages. Yet, striking racial/ethnic differences in incidence and mortality still persist in the United States and Florida. Eliminating such disparities requires a better understanding of factors responsible for the geographic and ethnic differences in prostate cancer late stage incidence and mortality over time. Percentages of advanced-stage prostate cancer diagnosis were analyzed yearly from 1981 through 2005 for each county of Florida and three ethnic subgroups (white, black, Hispanic). All three ethnic groups experienced a 50% decline in the state-average proportion of late-stage diagnosis. This drop, which started in the early 1990s when PSA became widely available, was the most pronounced for Hispanics whose rates is now similar to white non-Hispanics; black non-Hispanics still have a 25% larger rate compared to the two other ethnic groups. Interestingly, the total number of diagnosed cases kept increasing for black and Hispanics, while it started declining slowly for white in the early 1990s. These temporal trends are however not uniform across Florida; cluster and boundary analysis revealed geographical disparities that were substantial for all ethnic groups before the mid 1990s. The gap among Florida counties is narrowing with time as the percentage of late-stage diagnosis is decreasing. One outlier is the Big Bend region of Florida where the decline in late-stage diagnosis has been the slowest in all Florida for both white and black males. While this paper focused on the geographic distribution of race-based disparities in advanced-stage prostate cancer diagnosis in Florida, the approach can be easily generalized to other states and cancer sites, with clear applications in (a) monitoring and surveillance of cancer incidence and mortality, (b) the generation of hypotheses for in depth individual studies of risk factors that are causal, or impact survival; and (c) establishing the rationale for targeted cancer control interventions, including consideration of health services needs, and resource allocation for screening and diagnostic testing. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1818.