Prostate Cancer Screening Rates Research Articles

A pilot randomized clinical trial of a smartphone-based application to support at-home PSA screening and culturally tailored prostate cancer education for African American men: A study protocol

BackgroundProstate cancer is the most diagnosed cancer in Black/African American men (AA) and the second‑leading cause of cancer-related deaths. A prostate-specific antigen (PSA) blood test is an early detection screening tool for prostate cancer, but uptake of PSA screening remains low among AA men. Greater PSA screening rates among AA men, coupled with earlier treatment, may reduce disparities in prostate cancer outcomes, including mortality. The current pilot study will test the first-of-its-kind mobile health (mHealth) app to improve prostate cancer knowledge and increase PSA screening uptake among AA men using home-based screening methods. MethodsAA men aged 55 to 69 and are not up to date with PSA screening will be randomly assigned 1:1 to receive a prostate cancer screening app: Prevention Taskforce App (Taskforce App; control condition) or the Prostate Cancer Genius App (Genius App; intervention condition), which was developed specifically for AA men. ResultsWe will evaluate the preliminary efficacy of the apps via post-intervention group differences on the validated 18-item Prostate Cancer Knowledge Scale (primary outcome). We will also explore post-intervention group differences in perceived engagement, accessibility, and acceptability between the apps. Finally, we will derive preliminary estimates of PSA screening rates between study conditions and identify mechanisms of screening adherence. DiscussionmHealth apps offer promise to improve prostate cancer knowledge and screening rates among AA men. Demonstrating the preliminary efficacy of the Genius App will support future fully-powered mHealth interventions to address health disparities.

Effectiveness of a community-based health education intervention on prostate cancer fatalism: a quasi-experimental study.

prostate cancer is categorized as the most common cancer in males in 2020 in Kenya at 21.9%. The major challenge with prostate cancer in Low and Middle-Income Countries is the presentation of patients with advanced disease. The rate of prostate cancer screening is low across African countries which has been associated with low knowledge and fatalistic beliefs. The study aimed to assess the effectiveness of community-based health education on prostate cancer fatalism. the study design was quasi-experimental. The study was conducted in Kiambu County in the Gatundu North and Kiambu sub-counties in Kenya. A total of 288 men were selected per arm of the study using stratified random sampling. Data were collected using a structured questionnaire at baseline and post-intervention. The intervention was health education through home visits by a Community Health Worker. in the study, fatalism was associated with prostate cancer screening (P<0.05). There was a significant decrease in prostate cancer fatalism for the attributes of pessimism, pre-determination, and death inevitability in the intervention arm post-intervention. In contrast, in the control arm, there was no significant decrease. Post-intervention, the proportion of respondents with a high perception of fatalism decreased from 51% to 23.6% (P<0.05) in the intervention arm. In contrast, in the control arm, there was no significant decrease. prostate cancer fatalism significantly influenced prostate cancer screening. Community-based health education significantly reduced pessimism, death inevitability, and pre-destination beliefs about prostate cancer. Tailored culturally relevant health education is an effective strategy to address fatalistic beliefs.

Talk, test, and take one click to curb prostate cancer mortality.

6541 Background: Prostate cancer remains the most commonly diagnosed cancer and the second leading cause of cancer-related death in men in the United States. BronxCare Health System (BCHS) serves the Bronx neighborhoods of Morris Heights, Fordham South, and Mount Hope, notable for the highest prostate cancer incidence rate in New York City as per the American Cancer Society Cancer Action Network report 2019, highlighting the need for prostate cancer screening among the patient population we serve. An anonymous voluntary paper survey was performed in 2019 at BCHS to determine primary care physician understanding and implementation of current PSA testing guidelines. The study showed that primary care providers at BCHS approach PSA testing in a wide variety of ways and screen a wide age range of patients suggesting a need for intervention. An electronic medical record (EMR) decision support tool activated during primary care visits for men aged 55-69 years was implemented beginning January 1, 2021 which facilitates the provider and patient engagement in a shared decision-making discussion. This a follow-up study to determine the effect of this EMR application on PSA order rates and prostate cancer diagnosis rates at BCHS. Methods: The total number of patients who had PSA and lipid panel (LP) screening were extracted from the EMR of BCHS for potentially eligible men (aged 55-69) seen during primary care visits during the years 2016-2022. LP is done annually as a part of routine screening for adults aged 55-69 and is taken as an equivalent of primary care visits. PSA screening rates were compared to LP screening rates to control for unforeseen variables. Similarly, the number of newly-diagnosed prostate cancers among the same population of men was extracted for the years 2016-2021. Data for 2022 is still not available. 2016-2020 are pre-EMR and 2021 and 2022 are post-EMR flag years. The pre and post-EMR flag PSA and prostate cancer diagnosis numbers were compared by calculating Z scores and p-values. Results: The year-wise PSA, LP, and newly-diagnosed prostate cancers (PC) are tabulated below. The proportion of men who had PSA testing among all men aged 55-69 who had LP testing in each pre-EMR flag year was compared to each post-EMR flag year. A significant increase (p &lt; 0.00001) was noted in the proportion of men who had PSA screening after implementation of the EMR application. Similarly, the proportion of men with newly-diagnosed prostate cancer among all men aged 55-69 who had PSA screening significantly increased after EMR application (p &lt; 0.00001). Conclusions: A decision support tool embedded in the EMR has been an effective approach in increasing prostate cancer screening rates and may help curb prostate cancer mortality in our patient population as early detection in right men at the right age has the potential to reduce prostate cancer mortality. [Table: see text]

MP75-02 A SINGLE-CENTER RETROSPECTIVE REVIEW OF PROSTATE CANCER SCREENING AMONG TRANSGENDER AND NON-BINARY PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP75-02 A SINGLE-CENTER RETROSPECTIVE REVIEW OF PROSTATE CANCER SCREENING AMONG TRANSGENDER AND NON-BINARY PATIENTS Mona Ascha, Christopher Alabastro-Gonzales, Keith Weissman, Emily Chwa, Stephanike Erickson, Dylan Felt, Lauren Beach, Sumanas W. Jordan, and Diana K. Bowen Mona AschaMona Ascha More articles by this author , Christopher Alabastro-GonzalesChristopher Alabastro-Gonzales More articles by this author , Keith WeissmanKeith Weissman More articles by this author , Emily ChwaEmily Chwa More articles by this author , Stephanike EricksonStephanike Erickson More articles by this author , Dylan FeltDylan Felt More articles by this author , Lauren BeachLauren Beach More articles by this author , Sumanas W. JordanSumanas W. Jordan More articles by this author , and Diana K. BowenDiana K. Bowen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003349.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transgender and non-binary (TGNB) individuals face many barriers to accessing healthcare, and appropriate health screenings are often missed. Prostate cancer screening among the TGNB designated male at birth (DMAB) population is not well reported. This study examines screening patterns among TGNB DMAB patients at an urban tertiary care institution. METHODS: A system-wide data search was performed from March 2019-February 2021 to flag any encounters containing a diagnosis code for gender dysphoria, notation within structured demographic gender identity fields, or a clinical note with TGNB-related keyword. Charts were reviewed and all patients conclusively TGNB DMAB over the age of 40 were included as eligible for prostate-specific antigen (PSA) screening. Rates of screening as defined by any PSA were calculated according to AUA guidelines. RESULTS: Overall 190 patients had complete data and were eligible. Four patients were excluded from screening analysis with a history of prostate cancer; only 1 was on hormone therapy at the time of diagnosis. The median (IQR) age was 55.5 [48.3, 65.5] years and 19.2% African American race. The majority identified as transgender women (n=189, 98.4%). One hundred and fifty-five (80.7%) patients were on estrogen therapy. Ninety-one (47.4%) patients had received some type of gender-affirming surgery, with 20% orchiectomy and 16% vaginoplasty. The rate of lifetime prostate cancer screening after transition was 26.6% for patients >40 years of age and 20.6% for those 55-69 years of age. Multiple regression analysis of predictor variables including employment status, insurance status, education, hormone therapy, and race revealed no significant association with any prostate cancer screening being performed CONCLUSIONS: Prostate cancer screening rates in the TGNB DMAB population are lower than institutional and national rates for cisgender men. Further investigation into barriers as well as appropriate screening protocols specific to the TGNB population is needed. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1079 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mona Ascha More articles by this author Christopher Alabastro-Gonzales More articles by this author Keith Weissman More articles by this author Emily Chwa More articles by this author Stephanike Erickson More articles by this author Dylan Felt More articles by this author Lauren Beach More articles by this author Sumanas W. Jordan More articles by this author Diana K. Bowen More articles by this author Expand All Advertisement PDF downloadLoading ...

Breast and prostate cancer screening rates by cognitive status in US older adults.

For most older adults with dementia, the short-term harms and burdens of routine cancer screening likely outweigh the delayed benefits. We aimed to provide a more updated assessment of the extent that US older adults with dementia receive breast and prostate cancer screenings. Using the Health and Retirement Study (HRS) Wave 12 (2014-2015) linked to Medicare, we examine rates of breast and prostate cancer screenings in adults 65+ years by cognitive status. We used claims data to identify eligibility for screening and receipt of screening. We used a validated method using HRS data to define cognitive status. The analytic sample included 2439 women in the breast cancer screening cohort and 1846 men in the prostate cancer screening cohort. Average ages were 76.8 years for women and 75.6 years for men, with 9.0% and 7.6% with dementia in each cohort, respectively. Among women with dementia, 12.3% were screened for breast cancer. When stratified by age, 10.6% of those 75+ and have dementia were screened for breast cancer. When stratified by predicted life expectancy, 10.4% of those with predicted life expectancy of <10 years and have dementia were screened for breast cancer. Among men with dementia, 33.9% were screened for prostate cancer. When stratified by age, 30.9% of those 75+ and have dementia were screened for prostate cancer. When stratified by predicted life expectancy, 34.4% of those with predicted life expectancy of <10 years and have dementia were screened for prostate cancer. Using multivariable logistic regression, dementia was associated with lower odds of receiving breast cancer screening (OR 0.36, 95% CI 0.23-0.57) and prostate cancer screening (OR 0.58, 95% CI 0.36-0.96). Our results suggest potential over-screening in older adults with dementia. Better supporting dementia patients and caregivers to make informed cancer screening decisions is critical.

Breast, Colorectal, Lung, Prostate, and Cervical Cancer Screening Prevalence in a Large Commercial and Medicare Advantage Plan, 2008–2020

This study aimed to comprehensively assess breast, colorectal, cervical, lung, and prostate cancer screening rates and trends in the United States over time among individuals for whom screening is recommended by the United States Preventive Services Task Force (USPSTF). This retrospective study was conducted in two-year intervals from January 1, 2008 to February 29, 2020, using Optum’s de-identified Clinformatics® Data Mart Database, which includes Medicare Advantage and commercially insured members. Screening-eligible individuals, who had not previously had the cancer being screened and met USPSTF criteria for screening, were identified at various time points within the study timeframe for relevant screening tests within five cancer types: breast, colorectal, cervical, lung, and prostate. In the 2020 analysis period, patients who were eligible for cancer screening included: breast: 1,620,588; colorectal: 2,763,736; cervical: 1,371,506; lung: 1,491,594; prostate: 1,126,249. Breast and cervical cancer screening prevalence rates were highest (64.4% and 63.8%, respectively), followed by colorectal (29.5%), prostate (11.7%), and lung (3.8%). Black/African American individuals and Hispanics had moderately low screening rates for cervical (58.6%) and breast (61.8%) cancer, respectively; Hispanics had the lowest screening rates for prostate cancer (6.1%). Those residing in the West had lower screening rates for breast (58.9%), cervical (62.1%), and prostate (5.6%) cancer. Screening rates remained stable over time for breast, colorectal, and lung cancer, and changed significantly for cervical (-9.5%, 2012–2020) and prostate (+7.3%, 2008–2020) cancer. Real-world cancer screening rates remain suboptimal and low, and efforts to increase screening uptake and reduce cancer health disparities remain critical.

Prostate Cancer Screening Disparities in Persons Experiencing Homelessness.

The purpose of this study was to assess prostate-specific antigen (PSA) testing rates in persons experiencing homelessness (PEH), identify factors associated with screening, and compare PSA screening rates in PEH with a matched cohort of persons not experiencing homelessness (non-PEH). We identified 9,249 potentially eligible PEH cared for at a large metropolitan hospital system from an institutional registry of all patients who presented to the health care system as homeless from 2014 to 2021. Homelessness was defined by the presence of the Z-code for homelessness (Z59), the listed address matching to the address of a homeless shelter or other transitional housing or a positive screen for homelessness. A matched cohort of 10,000 non-PEH was generated for comparison. Univariate chi-square analysis and multivariate logistic regression were performed to evaluate variables associated with PSA testing. A total of 1,605 PEH and 3,413 non-PEH were eligible for PSA screening within the study timeframe. Half of PEH were Black (50%). Medicaid was the most common insurance (51%), followed by Medicare (18%). PEH were less likely to have a PCP (58% v 81%, P < .001) and had a significantly lower PSA testing rate (13% v 34%, P < .001) compared with non-PEH. Univariate analysis revealed that PSA testing was more common in PEH who were employed (P < .001), had private insurance or Medicare (P < .001), or had an established primary care provider (PCP; P < .001). Multivariate analysis confirmed that having a PCP (OR, 2.54; 95% CI, 1.62 to 4.00; P < .001) significantly increased the likelihood of PSA testing in PEH. PEH experience low rates of prostate cancer screening. Interventions to increase screening in this population, including increased PCP access, are needed.

Prostate Cancer Screening Disparities in Persons Experiencing Homelessness

<h3>Purpose/Objective(s)</h3> Persons experiencing homelessness (PEH) face barriers to cancer screening, leading to cancer diagnosis at more advanced stages. Data on prostate specific antigen (PSA) screening in this population is scarce. The aim of this study was to 1) assess PSA testing rates in PEH and identify factors associated with screening and 2) compare PSA screening rates in PEH with persons not experiencing homelessness (non-PEH). <h3>Materials/Methods</h3> This is an IRB approved study of PEH and non-PEH cared for at a large metropolitan hospital system from 2014 to 2021. We identified PEH from a prospective institutional registry which started screening for homelessness in January 2014. Homelessness was defined by either the presence of the Z-code for homelessness (Z59) within the medical record, the listed address was matched to homeless shelters or other transitional housing, or the patient identified as homeless. Institutional CPT and HCPCS billing codes for PSA testing were available beginning 01/01/2017 and cross-referenced to identify patients who underwent PSA testing at least once between 01/01/2017 and 12/31/2021. We extracted PSA testing information for a matched cohort of non-PEH based on sex, age, county of residence, and date of last encounter for comparison. We included men ages 50-69 that lived in our institution's county or an immediately adjacent county. The primary outcome was to assess the rate of PSA testing in the past 5 years in accordance with national screening guidelines (USPSTF, AUA, ACS) and to identify factors associated with PSA testing in PEH. <h3>Results</h3> A total of 9,249 PEH were identified, with 1,605 eligible for PSA screening (men between ages 50-69) within the study timeframe; 3,421 non-PEH were eligible for screening comparison. The median age of PEH was 58.0 years old and the majority of PEH were Black (50%) or White (43%). 67% of PEH were current tobacco users, 52% current alcohol users, and 34% current illicit drug users. Medicaid was the most common insurance (51%) followed by Medicare (19%) and private insurance (4%). PEH were less likely to have a PCP (58% vs 81%, p<0.001) and had a significantly lower PSA testing rate (13% vs 34%, p<0.001) compared to non-PEH. On univariate analysis, PEH were more likely to be Black (p<0.001), single (p<0.001), unemployed (p<0.001) and have Medicaid/no insurance (p<0.001). On multivariate analysis, each of these associations remained significant; most notably, lack of a PCP (OR=1.78; 95% CI 1.35-2.30, p<0.001) or PSA testing (OR=1.63; 95% CI, 1.25-2.14, p<0.001) were associated with increased odds of being homeless. Within the homeless population, multivariate analysis showed that having a PCP (OR=2.58; 95% CI, 1.64-4.05) significantly increased the odds of getting PSA testing. <h3>Conclusion</h3> PEH experience low rates of prostate cancer screening. Interventions to increase screening in this population, including increased PCP access, are warranted.

The association of sexual orientation with prostate, breast, and cervical cancer screening and diagnosis.

Data on heterogeneity in cancer screening and diagnosis rates among lesbians/gays and bisexuals (LGBs) is lacking. Recent studies showed that LGBs have decreased healthcare utilization compared to heterosexual counterparts. Few studies have examined how sexual orientation impacts cancer screening and prevalence. We, therefore, investigated the association between sexual orientation and prevalent sex-specific cancer including prostate (PCa), breast (BC), and cervical (CC) cancer. This was a cross-sectional survey-based US study, including men and women aged 18 + from the Health Information National Trends Survey (HINTS) database between 2017 and 2019. The primary endpoint was individual-reported prostate, breast, and cervical cancer screening and prevalence rates among heterosexual and LGB men and women. Multivariable logistic regression analyses assessed association of various covariates with undergoing screening and diagnosis of these cancers. Overall, 4,441 and 6,333 heterosexual men and women, respectively, were compared to 225 and 213 LGB men and women, respectively. LGBs were younger and less likely to be screened for PCa, BC, and CC than heterosexuals. A higher proportion of heterosexual women than lesbian and bisexual women were screened for CC with pap smears (95.36% vs. 90.48% and 86.11%, p ≤ 0.001) and BC with mammograms (80.74% vs. 63.81% and 45.37%, p ≤ 0.001). Similarly, a higher proportion of heterosexual men than gay and bisexual men were screened for PCa with PSA blood tests (41.27% vs. 30.53% and 27.58%, p ≤ 0.001). There were more heterosexuals than LGBs screened for CC, BC, and PCa. However, no association between sexual orientation and cancer diagnosis was found. Healthcare professionals should be encouraged to improve cancer screening among LGBs.

Regional and Racial Trends in US Prostate Cancer Screening

Objective: In this study, we examined whether self-reported prostate cancer screening rates differed by ethnicity. Methods: We used 2014 and 2018 data from the Behavioral Risk Factor Surveillance System (BRFSS) to determine if self-reported screening rates differed by ethnicity and year, while we controlled for geographic, demographic, and health factors. We also investigated factors that may influence screening rates. Results: Self-reported screening rates decreased between 2014 and 2018, both overall and by each ethnicity. Blacks had significantly higher odds of reporting a PSA test than Whites (OR = 1.13 ± 0.01 in 2014; 1.14 ± 0.01 in 2018); all other group had lower odds than Whites. By ethnicity, only Blacks and Native Hawaiians/Pacific Islanders had higher odds of being asked the questions than Whites; all other groups had lower odds. Overall screening rates were positively correlated with prostate cancer incidence rates by state but not for any racial group individually. Conclusions: Self-reported PSA test rates are declining, are associated with PSA test knowledge, are less likely in non-black minorities, and may be influenced by healthcare discussions and state-level incidence rates

Trends in breast and prostate cancer screening and diagnostic procedures during the COVID-19 pandemic in central Massachusetts

PurposeWe calculated rates of breast and prostate cancer screening and diagnostic procedures performed during the COVID-19 pandemic through December 2021 compared to the same months in 2019 in a large healthcare provider group in central Massachusetts.MethodsWe included active patients of the provider group between January 2019 and December 2021 aged 30–85 years. Monthly rates of screening mammography and digital breast tomosynthesis, breast MRI, total prostate specific antigen (PSA), and breast or prostate biopsy per 1,000 people were compared by year overall, by age, and race/ethnicity. Completed procedures were identified by relevant codes in electronic health record data.ResultsRates of screening mammography, tomosynthesis, and PSA testing reached the lowest levels in April–May 2020. Breast cancer screening rates decreased 43% in March and 99% in April and May 2020, compared to 2019. Breast cancer screening rates increased gradually beginning in June 2020 through 2021, although more slowly in Black and Hispanic women and in women aged 75–85. PSA testing rates decreased 34% in March, 78% in April, and 53% in May 2020, but rebounded to pre-pandemic levels by June 2020; trends were similar across groups defined by age and race/ethnicity.ConclusionThe observed decline in two common screening procedures during the COVID-19 pandemic reflects the impact of the pandemic on cancer early detection and signals potential downstream effects on the prognosis of delayed cancer diagnoses. The slower rate of return for breast cancer screening procedures in certain subgroups should be investigated to ensure all women return for routine screenings.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10552-022-01616-4.

The effect of COVID-19 on prostate cancer testing in Australia

AimThe effects of the COVID-19 pandemic on healthcare in Australia have yet to be fully determined. There are well documented decreases in the rates of screening and diagnostic testing for many cancers in 2020, with commensurate stage migration of cancers when they are eventually detected. We aimed to determine whether there was a decrease in the rate of prostate cancer (PC) screening and testing in Australia in 2020.MethodData was extracted from the Department of Human Services (DHS) website for Medicare Benefits Schedule (MBS) item numbers for tests pertinent to detection of Prostate Cancer. This data is de-identified and publicly available. Data was analysed at both a national, and a state level.ResultsFor 2020 nationwide the percentage change for prostate cancer testing was minor with 97% as many PSA tests, 99% as many prostate MRIs, and 105% as many prostate biopsies as the average for the preceding years. The differences were not significant (PSA tests p = 0.059 and prostate biopsies p = 0.109). The predicted values are fairly similar to both the average values for the preceding 5 years and the actual number of tests done in 2020. With exception of PSA tests in Victoria the actual number of tests performed was within the 95% Prediction Interval (performed: 167,426; predicted 171,194–196,699; p = 0.015).ConclusionThe current pandemic has had a widespread reach across Australia, with varying impact across each state and territory. Contrary to the trends across the world, our data suggest that during 2020 in Australia most areas remained unaffected in terms of prostate cancer testing excluding Victoria, which had statistically significant decrease in the number of PSA tests correlating with the extended lockdown that occurred in the state.

Cancer Screening Differences Among Muslims and Non-Muslims: Insights from the Chicago Multiethnic Prevention and Surveillance Study.

While cancer screening disparities along socioeconomic and racial/ethnic lines are well studied, differences based on religious affiliation are under-researched. Though diverse in terms of race/ethnicity, Muslim Americans appear to share values and beliefs that similarly inform their health and healthcare seeking behaviors. Cancer screening disparities among Muslim Americans are also understudied. To examine differences in cancer screening behaviors based on Muslim affiliation, we analyzed data from a longitudinal cohort study examining lifestyle, healthcare access, environmental, and genetic factors on the health of Chicagoans. Of 7552 participants, 132 (1.7%) were Muslim. Between Muslim and non-Muslims, there were no significant differences in prostate, cervical, and breast cancer screening rates, but Muslims were less likely to undergo colorectal cancer screening. When differences in obesity and insurance status were accounted for in a multivariate regression model, religious affiliation was no longer significantly associated with screening rates. Religious values can influence cancer screening behaviors; hence, tracking cancer screening along religious lines may illuminate previously unknown disparities. Our analysis of a predominately African American cohort of Chicagoans, however, did not reveal religious affiliation to predict cancer screening disparities.

Does Perceived Racism Affect Prostate Cancer Screening Rates and Patient-Provider Shared Discussions Among Black and White Men?

While Black men face a significant cancer risk burden in the United States, confronting complex historical and social issues such as racism and discrimination undermines care. This study explored associations between perceived racism, prostate screening rates, and shared medical discussions. We performed data analysis of merged Behavioral Risk Factor Surveillance System (BRFSS) survey data. Data were limited to Black and White men. We used propensity score analysis to assess the race-associated effects on outcomes. Black men were less likely than White men to receive discussions of both prostate-specific antigen (PSA) screening advantages χ2(4.54), p &lt; .05 and disadvantages χ2(41.62), p &lt; .001. The effects of perceived racism and its interaction with race were statistically non-significant for all PSA outcomes. Compared with their White counterparts, Black men were significantly less likely to be advised of potential PSA screening advantages and harms. This inequity in health care delivery has implications concerning disease prevention and informed decision-making.

Factors associated with PSA testing in men ≥ 50 years in Ireland

Abstract Background Ireland has among the highest rates of prostate cancer in the EU, primarily due to widespread PSA screening. PSA screening is not recommended for asymptomatic men. Due to the potential for harm to the patient, and the economic and clinical repercussions for the healthcare system caused by inappropriate screening, this study aimed to investigate associations between PSA screening and sociodemographic, lifestyle, and health-related factors in men ≥50 years in Ireland. Methods A cross-sectional study was completed using data from Wave 4 of The Irish Longitudinal Study on Aging (TILDA), a nationally representative sample of community dwellers ≥ 50 years in Ireland. Participants self-reported having or not having a PSA test to screen for prostate cancer in the previous two years. Variables were entered into a multivariable logistic regression to estimate adjusted odds ratios (OR) for associations between PSA testing and the factors of interest. Results There were 2,426 male participants, with 68% reporting a PSA test in the previous two years. In adjusted analysis, older age (OR 1.78, 95%CI 1.32-2.31), third level education (OR 1.34, 95%CI 1.07-1.69) and a higher household net income (OR 2.14, 95% CI 1.52-3.02) increased the likelihood of PSA testing. Health-related factors positively associated with PSA testing screening were private health insurance (OR 1.89, 95%CI 1.52-2.35), blood pressure measurement in the previous year (OR 8.80, 95%CI 6.06-12.77) and a positive family history of cancer (OR 1.42, 95%CI 1.13-1.78). Conclusions High rates of prostate cancer screening are taking place in Ireland, despite the absence of a population-based screening programme. Men of older age, higher socioeconomic status and who demonstrate health-protective-behaviours have an increased risk of PSA screening. This subgroup of the population should be targeted to increase awareness of the potential benefits and harms of PSA testing. Key messages Rates of PSA screening remain high in Ireland, despite the absence of a population-based screening programme. Increased awareness of the potential harms and benefits of PSA screening is needed.

The association of sexual orientation with prostate, breast, and cervical cancer screening and diagnosis.

129 Background: Data on heterogeneity in cancer screening and diagnosis rates among lesbians/gays and bisexuals is lacking. Recent studies showed that lesbians/gays and bisexuals have decreased healthcare utilization compared to heterosexual counterparts and continue to experience discrimination in healthcare. Few studies have examined how sexual orientation impacts cancer screening and prevalence. We, therefore, investigated the association between sexual orientation and prevalent sex-specific cancer including prostate, breast, and cervical cancer. Methods: This was a cross-sectional survey-based US study, including men and women aged 18+ from the Health Information National Trends Survey (HINTS) database between 2017-2019. The primary endpoint was individual-reported prostate, breast, and cervical cancer screening and prevalence rates among heterosexual and LGB men and women. Multivariable logistic regression analyses assessed association of various covariates with undergoing screening and diagnosis of these cancers. Results: Overall, 4,441 and 6,333 heterosexual men and women, respectively, were compared to 225 and 213 lesbian/gay and bisexual men and women, respectively. Lesbians/gays and bisexuals were younger and less likely to be screened for prostate, breast, and cervical cancer than heterosexuals. A higher proportion of heterosexual women than lesbian and bisexual women were screened for cervical cancer with pap smears (95.36% vs. 90.48% and 86.11%, p = &lt; 0.001) and breast cancer with mammograms (80.74% vs. 63.81% and 45.37%, p = &lt; 0.001). Similarly, a higher proportion of heterosexual men than gay and bisexual men were screened for prostate cancer with PSA blood tests (41.27% vs. 30.53% and 27.58%, p = &lt; 0.001). Conclusions: Lesbians/gays and bisexuals in the US may be less likely to undergo screening of sex-specific prevalent malignancies, including prostate, breast, and cervical cancer. Healthcare professionals should be encouraged to improve cancer screening among lesbians/gays and bisexuals.

Promotion of prostate cancer screening equity: A quality improvement education initiative.

140 Background: Black men are disparately affected by prostate cancer (PC). They are more likely to develop PC and at an earlier age when the disease is more advanced at diagnosis. As a result, Black men are two to three times more likely to die from PC than white men. Given these disparities, experts increasingly promote screening for PC in Black men at a younger age. Methods: To inform implementation of a quality improvement education (QIE) project in three primary care practices in Maryland, a zip code analysis of the prevalence of PC was performed. Maryland practices were selected due to higher rates of PC in regions of the state and significant Black populations (Table). The QIE initiative started with a baseline practice assessment survey (including information on panel size, patient demographics, PC screening/treatment approaches, and barriers) and an analysis of current PC screening rates. Health system leaders and champions from the practice sites received training on patient-centered conversations with high-risk Black patients and concerning QIE planning. The champions developed rapid cycle improvement plans to implement increased screening using a patient-oriented online educational platform ( Dr. PSA ), as well as posters, and placards for patient education. Results: The overall national prevalence of PC in Medicare Fee-for-Service Program beneficiaries in 2018 was 2.65%. For Black beneficiaries the overall prevalence was 2.89%. Prevalence for beneficiaries in specific Maryland zip codes are detailed in Table. *Data not available; Source: NMQF Prostate Cancer Index Baseline practice assessment data revealed that patient panels ranged from 4,000 to 58,163 patients, with Black patients accounting for 50% or more of two of the practices and 25 to 50% of the third practice. Barriers to screening identified include financial issues, insurance restrictions, and lack of knowledge about PC and screening. Baseline screening rates are approximately 75%. Conclusions: Zip code prevalence analysis and baseline practice assessment data confirmed the relevance of implementing a QIE initiative in the three selected sites. Through a mixed-methods evaluation study, practice staff knowledge, attitudes, and self-reported practices will be assessed pre- and post-QIE initiative to assess impact of the initiative and determine opportunities for further improvement in PC screening practices.[Table: see text]

The Role of Health Literacy in Prostate Cancer Screening

ObjectiveTo determine if there is an association between self-reported health literacy and rates of prostate cancer screening through PSA testing. MethodsThis secondary data analysis utilized information from the 2016 Behavioral Risk Factor Surveillance System (BRFSS). The primary exposure was self-reported health literacy, and the primary outcome was whether patients underwent prior PSA testing. Males 55-69 years old from 13 states were included in the study and were excluded if they had any missing data. Participants were categorized into low, moderate, or high level of health literacy. Confounders were adjusted for using binary logistic regression. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. ResultsA total of 12,149 participants were included. Five percent of participants reported low health literacy, 54% moderate health literacy, and 41% high health literacy. Compared with study participants who self-reported high levels of health literacy, the odds of undergoing PSA testing were 59% lower in those with low health literacy (OR 0.41; 95% CI 0.28-0.64) and 30% lower in those with moderate health literacy (OR 0.70; 95% CI 0.60-0.83). ConclusionsOur research demonstrates a positive association between self-reported health literacy and the likelihood of PSA screening. While PSA screening can be controversial, health literacy may serve as a window into which patients are more likely to be proactive in their urologic care. Future studies examining how health literacy effects other urologic conditions is necessary.

Association of Cancer Screening Deficit in the United States With the COVID-19 Pandemic

The COVID-19 pandemic led to sharp declines in cancer screening. However, the total deficit in screening in the US associated with the pandemic and the differential impact on individuals in different geographic regions and by socioeconomic status (SES) index have yet to be fully characterized. To quantify the screening rates for breast, colorectal, and prostate cancers associated with the COVID-19 pandemic in different geographic regions and for individuals in different SES index quartiles and estimate the overall cancer screening deficit in 2020 across the US population. This retrospective cohort study uses the HealthCore Integrated Research Database, which comprises single-payer administrative claims data and enrollment information covering approximately 60 million people in Medicare Advantage and commercial health plans from across geographically diverse regions of the US. Participants were individuals in the database in January through July of 2018, 2019, and 2020 without diagnosis of the cancer of interest prior to the analytic index month. Analytic index month and year. Receipt of breast, colorectal, or prostate cancer screening. Screening for all 3 cancers declined sharply in March through May of 2020 compared with 2019, with the sharpest decline in April (breast, -90.8%; colorectal, -79.3%; prostate, -63.4%) and near complete recovery of monthly screening rates by July for breast and prostate cancers. The absolute deficit across the US population in screening associated with the COVID-19 pandemic was estimated to be 3.9 million (breast), 3.8 million (colorectal), and 1.6 million (prostate). Geographic differences were observed: the Northeast experienced the sharpest declines in screening, while the West had a slower recovery compared with the Midwest and South. For example, percentage change in breast cancer screening rate (2020 vs 2019) for the month of April ranged from -87.3% (95% CI, -87.9% to -86.7%) in the West to -94.5% (95% CI, -94.9% to -94.1%) in the Northeast (decline). For the month of July, it ranged from -0.3% (95% CI, -2.1% to 1.5%) in the Midwest to -10.6% (-12.6% to -8.4%) in the West (recovery). By SES, the largest screening decline was observed in individuals in the highest SES index quartile, leading to a narrowing in the disparity in cancer screening by SES in 2020. For example, prostate cancer screening rates per 100 000 enrollees for individuals in the lowest and highest SES index quartiles, respectively, were 3525 (95% CI, 3444 to 3607) and 4329 (95% CI, 4271 to 4386) in April 2019 compared with 1535 (95% CI, 1480 to 1589) and 1338 (95% CI, 1306 to 1370) in April 2020. Multivariable analysis showed that telehealth use was associated with higher cancer screening. Public health efforts are needed to address the large cancer screening deficit associated with the COVID-19 pandemic, including increased use of screening modalities that do not require a procedure.

Prostate-specific antigen testing and opportunistic prostate cancer screening: a cohort study in England, 1998-2017.

BackgroundProstate cancer is a leading cause of cancer- related death. Interpreting the results from trials of screening with prostate-specific antigen (PSA) is complex in terms of defining optimal prostate cancer screening policy.AimTo assess the rates of, and factors associated with, the uptake of PSA testing and opportunistic screening (that is, a PSA test in the absence of any symptoms) in England between 1998 and 2017, and to estimate the likely rates of pre-randomisation screening and contamination (that is, unscheduled screening in the ‘control’ arm) of the UK-based Cluster Randomised Trial of PSA Testing for Prostate Cancer (CAP).Design and settingOpen cohort study of men in England aged 40–75 years at cohort entry (1998–2017), undertaken using the QResearch database.MethodEligible men were followed for up to 19 years. Rates of PSA testing and opportunistic PSA screening were calculated; Cox regression was used to estimate associations.ResultsThe cohort comprised 2 808 477 men, of whom 631 426 had a total of 1 720 855 PSA tests. The authors identified that 410 724 men had opportunistic PSA screening. Cumulative proportions of uptake of opportunistic screening in the cohort were 9.96% at 5 years’, 22.71% at 10 years’, and 44.13% at 19 years’ follow-up. The potential rate of contamination in the CAP control arm was estimated at 24.50%.ConclusionA substantial number of men in England opt in to opportunistic prostate cancer screening, despite uncertainty regarding its efficacy and harms. The rate of opportunistic prostate cancer screening in the population is likely to have contaminated the CAP trial, making it difficult to interpret the results.