Abstract 3721: Rapid widening of age and race health disparities in prostate cancer outcomes within the United States, 1973-2014

Abstract

Abstract Introduction Little is known concerning how cancer-outcome disparities have changed over time. We investigated how age and race disparities in prostate cancer (PCa) survival have changed in the USA over the last 40 years. Methods We utilized the SEER database to track PCa outcomes. Incl. criteria: subjects with PCa diagnosed 1973 - 2008, aged 50-89 yrs. Excl. criteria: multiple primary cancers, unknown stage. Results 658,916 PCa patients were analyzed. Median follow up for alive patients was 54m (interquart. range 39-75m). Median age of diagnosis decreased from 73 to 60 yrs from 1973 to 2008, and the proportion aged > = 70 yrs decreased from 62% to 40%. The proportion diagnosed with metastatic disease decreased from 18% to 4%; likewise amongst those with M0 disease the proportion with T3-4 decreased from 41% to 17%. The remainder of the results are confined to M0 disease. Four-year cancer specific death decreased progressively for all age groups. But whereas 4 year cancer specific mortality dropped from 24% to 3% in those aged 50-54, it only decreased from 38% to 18% in those aged 85-89. Whereas the hazard ratio (HR) for cancer-specific death for those aged 85-89 (50-54 year old subjects reference group) was 1.6 in 1973-9, in 2000-8 it was 10.9 (table). The widening age disparities were only marginally altered by incorporation of ‘tumor stage’ into the model. Similar widening age disparities were seen in metastatic disease. Race-related disparities also widened over the study period; the HR for death increasing from 1.1 (1973-79) to 1.3 (2000-8). Hazard ratios for prostate cancer-specific death stratified by year of diagnosis, stage M0Age1973-91980-91990-92000-950-4111155-91.11.01.11.060-41.11.11.51.265-91.11.11.81.670-41.21.22.22.375-91.21.32.93.580-41.41.53.86.185-91.61.75.010.9 Conclusions Age- and Race- related health disparities in survival outcomes in both metastatic and non-metastatic prostate cancer have greatly widened over the past 40 years; this effect appears to be accelerating and is not explained by delayed diagnosis. Since outcome disparities have grown against a backdrop of improved screening, diagnosis and treatment, it appears that measures targeted at these populations will be needed in order to redress the imbalance. Citation Format: Richard J. Lawrence, Damien Urban, Talia Golan, Akram Saad, Raanan Berger, Raya Leibowitz-Amit, Jair Bar, Robert Den, Jeffrey Goldstein, Zvi Symon. Rapid widening of age and race health disparities in prostate cancer outcomes within the United States, 1973-2014. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3721. doi:10.1158/1538-7445.AM2015-3721