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Kalavacherla S, Riviere P, Kalavacherla S, Anger JT, Murphy JD, Rose BS. Prostate Cancer Screening Uptake in Transgender Women. JAMA Netw Open 2024; 7:e2356088. [PMID: 38353948 PMCID: PMC10867675 DOI: 10.1001/jamanetworkopen.2023.56088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/17/2023] [Indexed: 02/16/2024] Open
Abstract
Importance There is no consensus in prostate-specific antigen (PSA) screening guidelines regarding transgender women despite their known prostate cancer risk. Objective To identify factors associated with recent (within the last 2 years) PSA screening in transgender women compared with cisgender men. Design, Setting, and Participants This case-control study used data from the 2018 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys to characterize rates of PSA screening for prostate cancer within the past 2 years and multivariable logistic regressions to characterize factors associated with recent screening among transgender women. The BRFSS program of the Centers for Disease Control and Prevention annually surveys over 400 000 US adults on behavioral risk factors, chronic illnesses, and use of preventive services. Respondents to the BRFSS who were cisgender men or transgender women 40 years or older and who had complete PSA testing responses and no prostate cancer history were included; 313 transgender women and 138 937 cisgender men met inclusion criteria. Matching was performed by age, race and ethnicity, educational level, employment, annual income, survey year, and cost barriers to care. Data were collected on November 2, 2022, and analyzed from November 2, 2022, to December 3, 2023. Main Outcomes and Measures Rates of and factors associated with recent PSA screening in transgender women. Results Among the 1275 participants included in the matched cohort (255 transgender women and 1020 cisgender men; 570 [44.7%] aged 55-69 years), recent PSA screening rates among transgender women and cisgender men aged 55 to 69 were 22.2% (n = 26) and 36.3% (n = 165), respectively; among those 70 years and older, these rates were 41.8% (n = 26) and 40.2% (n = 98), respectively. In the matched cohort, transgender women had lower univariable odds of recent screening than cisgender men (odds ratio [OR], 0.65 [95% CI, 0.46-0.92]; P = .02). In a hierarchical regression analysis adding time since the last primary care visit, effect size and significance were unchanged (OR, 0.61 [95% CI, 0.42-0.87]; P = .007). After adding whether a clinician recommended a PSA test, there was no statistically significant difference in odds of screening between transgender women and cisgender men (OR, 0.83 [95% CI, 0.45-1.27]; P = .21). The results were further attenuated when clinician-led discussions of PSA screening advantages and disadvantages were added (OR, 0.87 [95% CI, 0.47-1.31]; P = .32). In a multivariable logistic regression among transgender women, having a recommendation for PSA testing was the factor with the strongest association with recent screening (OR, 12.40 [95% CI, 4.47-37.80]; P < .001). Conclusions and Relevance In this case-control study of one of the largest cohorts of transgender women studied regarding PSA screening, the findings suggest that access to care or sociodemographic factors were not principal drivers of the screening differences between transgender women and cisgender men; rather, these data underscore the clinician's role in influencing PSA screening among transgender women.
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Affiliation(s)
- Sandhya Kalavacherla
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
- Center for Health Equity, Education, and Research, University of California, San Diego, La Jolla
| | - Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
- Center for Health Equity, Education, and Research, University of California, San Diego, La Jolla
| | - Sruthi Kalavacherla
- Center for Health Equity, Education, and Research, University of California, San Diego, La Jolla
- Department of Biology, Massachusetts Institute of Technology, Cambridge
| | - Jennifer T. Anger
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
- Department of Urology, University of California, San Diego, La Jolla
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
- Center for Health Equity, Education, and Research, University of California, San Diego, La Jolla
| | - Brent S. Rose
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
- Center for Health Equity, Education, and Research, University of California, San Diego, La Jolla
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Coughlin SS, Ayyala DN, Luque JS, Moore JX. Predictors of prostate cancer screening among African American men treated at an Academic Medical Center in the Southern United States. Curr Cancer Rep 2021; 3:81-94. [PMID: 33898998 PMCID: PMC8064558 DOI: 10.25082/ccr.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The controversy surrounding prostate cancer screening, coupled with the high rates of incidence and mortality among African American men, increase the importance of African American men engaging in an informed decision-making process around prostate cancer screening. PURPOSE To examine predictors of prostate cancer screening via the prostate-specific antigen (PSA) test. Secondary objectives were to examine whether African American men have been screened for prostate cancer; their confidence in making an informed choice about whether PSA testing is right for them; and whether they have talked with their provider about PSA testing and engaged in an informed decision-making process around prostate cancer screening. METHODS We conducted a study among a sample of African American men patients ages ≥ 40 years. RESULTS A total of 65 men completed the questionnaire (response rate = 6.5%). The mean age of the men was 64.4 years. Most of the participants (90.8%) reported a regular healthcare provider and that their provider had discussed the PSA test with them (81.3%). About 84.1% of the men ever had a PSA test, but only 38.0% had one in the past year. Most of the men reported that they make the final decision about whether to have a PSA test on their own (36.5%) or after seriously considering their doctor's opinion (28.6%). About 31.8% of the men reported that they share responsibility about whether to have a PSA test with their doctor. About half of the participants (49.2%) reported that they have made a decision about whether to have a PSA test and they are not likely to change their mind. The majority of the men (75%) perceived their risk of prostate cancer to be about the same level of risk as other men who were their age. The men's knowledge of prostate cancer was fair to good (mean prostate cancer knowledge scale = 10.37, SD 1.87). Knowledge of prostate cancer was positively associated with receipt of a PSA test (p < 0.0206). DISCUSSION The modest overall prostate cancer knowledge among these participants, including their risk for prostate cancer, indicates a need for prostate cancer educational interventions in this patient population.
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Affiliation(s)
- Steven S. Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Deepak Nag Ayyala
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - John S. Luque
- Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL USA
| | - Justin Xavier Moore
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
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Coughlin SS, Vernon M, Klaassen Z, Tingen MS, Cortes JE. Knowledge of prostate cancer among African American men: A systematic review. Prostate 2021; 81:202-213. [PMID: 33368465 DOI: 10.1002/pros.24097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/15/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Recent studies indicate that many African American men may not be making informed decisions about prostate cancer early detection. This is partly due to patients having limited knowledge about early detection of the disease. METHODS The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles (n = 235) published in English from 1993 through July 31, 2020 were identified using the following MESH search terms and Boolean algebra commands: prostate cancer and knowledge and African Americans. RESULTS Forty-two articles were eligible for inclusion. The results of this literature review indicate that many African American men have inadequate knowledge of prostate cancer and prostate cancer early detection. Studies indicate that knowledge of prostate cancer is particularly low among older, less-educated, lower-income, and unmarried men, along with those who lack a regular physician or health insurance. Many African American men are unaware that they are at increased risk of prostate cancer because of their age or race. CONCLUSIONS Culturally appropriate educational efforts are needed to inform African- American men about the pros and cons of prostate cancer early detection and about risk factors for the disease so that they can make an informed decision about whether prostate cancer early detection is right for them. Of particular concern is the prostate cancer knowledge of low-income and less-educated men, along with those who lack health care insurance or a regular provider.
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Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, USA
| | - Marlo Vernon
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Zachary Klaassen
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Urology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Martha S Tingen
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Jorge E Cortes
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
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Abstract
PURPOSE Fatalism is defined by feelings of pessimism, hopelessness, and powerlessness regarding cancer outcomes. Early researchers reported associations between race and cancer fatalism. Yet current evidence suggests that social determinants of health are better predictors of cancer fatalism than race. Therefore, the aim of this study was to examine the association between age, race, education, and cancer fatalism. METHODS Three hundred ninety (n = 390) women who attended a screening mammogram at the Joanne Knight Breast Health Center at Siteman Cancer Center at Washington University School of Medicine (St. Louis, MO) completed the Powe Fatalism Inventory (PFI), a 15-item self-report instrument used to operationalize cancer fatalism. We used Pearson's correlation, independent samples t-tests, one-way ANOVA with post hoc tests, and linear regression to analyze the relationships between PFI total scores and age, race, and education. RESULTS There were no differences between the mean PFI scores for Non-Hispanic Whites (1.89, SD 0.55) and African Americans (2.02, SD 0.76, p = 0.092, 95% CI 0.27 to 0.02). We found significant differences between the mean PFI scores across levels of education. Women who attained a high school degree or less (n = 72) reported higher PFI scores (2.24, SD 0.77) than women who attended some college or post-high school vocational training (n = 111; 1.95, SD 0.61) and women with a college or postgraduate degree (n = 206; 1.83, SD 0.57). When PFI score was regressed onto age, race, and education, only education significantly explained fatalism (B = -0.19, p < 0.001). CONCLUSIONS In this study, cancer fatalism did not differ between Non-Hispanic White and African American women attending a screening mammogram. However, lower educational levels were associated with higher cancer fatalism. The previously observed associations between race and cancer fatalism may be explained by racial disparities in social determinants of health, such as education. Importantly, study findings indicate that the people with the greatest need for cancer fatalism interventions are those with lower educational levels.
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Weprin SA, Parker DC, Jones JD, Kaplan JR, Giusto LL, Mydlo JH, Yu SJS, Lee DI, Eun DD, Reese AC. Association of Low Socioeconomic Status With Adverse Prostate Cancer Pathology Among African American Men Who Underwent Radical Prostatectomy. Clin Genitourin Cancer 2019; 17:e1054-e1059. [DOI: 10.1016/j.clgc.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/02/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
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Hewitt T, Killinger KA, Hiller S, Boura JA, Lutz M. Exploring Racial Differences Surrounding Prostate Cancer Screening: Beliefs and Attitudes in Community Dwelling Men Attending an Urban Men's Health Event. Am J Mens Health 2018; 12:1929-1936. [PMID: 29952245 PMCID: PMC6199456 DOI: 10.1177/1557988318784838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of the study was to explore attitudes/beliefs in men attending an urban health fair to explore barriers to prostate cancer (PCa) screening. Five hundred and forty-four men attending the PCa booth at the fair in 2014 or 2015 completed questionnaires about PCa. Data were examined using Pearson’s χ2, Fisher’s Exact, and Wilcoxon rank tests after grouping men by African American (AA) and non-African American ethnicity. Three hundred and twenty-six (60%) men were AA and two hundred and eighteen (40%) were non-AA (89% white). Median age (54 vs. 56 years) and prior PCa screening were similar between AA and non-AA; income (p = .044) and education (p = .0002) differed. AA men were less likely to have researched prostate-specific antigen (PSA) on the internet (p = .003), but more used TV (p = .003) and media (p = .0014) as information sources. Family members had a stronger influence over screening decisions for AA men (p = .005). After reading PSA information, AA men were more likely to still be confused (p = .008). A higher proportion of AA men were less worried about dying from PCa (p = .0006), but would want treatment immediately instead of watchful waiting (p < .0001). Interestingly, a higher proportion of AA men indicated that they would prefer not to know if they had PCa (p = .001). Ultimately, more AA men had a PSA done (98.4% vs. 95.1%; p = .031). When considering screening eligible men, a higher proportion of AA men had an abnormal PSA (13.1% vs. 5.3%; p = .037). AA men’s beliefs surrounding PCa differ from non-AA men, and should be considered when developing culturally appropriate education, screening, and treatment strategies for this group.
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Affiliation(s)
- Timothy Hewitt
- 1 Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kim A Killinger
- 1 Oakland University William Beaumont School of Medicine, Rochester, MI, USA.,2 Beaumont Hospital, Royal Oak, MI, USA
| | | | - Judith A Boura
- 1 Oakland University William Beaumont School of Medicine, Rochester, MI, USA.,2 Beaumont Hospital, Royal Oak, MI, USA
| | - Michael Lutz
- 1 Oakland University William Beaumont School of Medicine, Rochester, MI, USA.,2 Beaumont Hospital, Royal Oak, MI, USA
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Weiner AB, Matulewicz RS, Tosoian JJ, Feinglass JM, Schaeffer EM. The effect of socioeconomic status, race, and insurance type on newly diagnosed metastatic prostate cancer in the United States (2004-2013). Urol Oncol 2017; 36:91.e1-91.e6. [PMID: 29153624 DOI: 10.1016/j.urolonc.2017.10.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/24/2017] [Accepted: 10/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Understanding the characteristics of men who initially present with metastatic prostate cancer (mPCa) can better enable directed improvement initiatives. The objective of this study was to assess the relationship between socioeconomic status (SES) and newly diagnosed mPCa. MATERIALS METHODS All men diagnosed with PCa in the National Cancer Data Base from 2004 to 2013 were identified. Characteristics of men presenting with and without metastatic disease were compared. A 4-level composite metric of SES was created using Census-based income and education data. Multivariable logistic regression was used to evaluate the association between SES, race/ethnicity, and insurance and the risk of presenting with mPCa at the time of diagnosis. RESULTS Of 1,034,754 patients diagnosed with PCa, 4% had mPCa at initial presentation. Lower SES (first vs. fourth quartile; odds ratio [OR] = 1.39, 95% CI: 1.35-1.44), black and Hispanic race/ethnicity (vs. white; OR = 1.47, 95% CI: 1.43-1.51 and OR = 1.22, 95% CI: 1.17-1.28, respectively), and having Medicaid or no insurance (vs. Medicare or private; OR = 3.91, 95% CI: 3.78-4.05) were each independently associated with higher odds of presenting with mPCa after adjusting for all other covariates. CONCLUSIONS Lower SES, race/ethnicity, and having Medicaid or no insurance were each independently associated with higher odds of presenting with metastases at the time of PCa diagnosis. Our findings may partially explain current PCa outcomes disparities and inform future efforts to reduce disparities.
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Affiliation(s)
- Adam B Weiner
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Richard S Matulewicz
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffrey J Tosoian
- James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph M Feinglass
- Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Shenoy D, Packianathan S, Chen AM, Vijayakumar S. Do African-American men need separate prostate cancer screening guidelines? BMC Urol 2016; 16:19. [PMID: 27165293 PMCID: PMC4862049 DOI: 10.1186/s12894-016-0137-7] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2012, the United States Preventative Services Task Force issued new guidelines recommending that male U.S. residents, irrespective of race, no longer be screened for prostate cancer. In African American men, the incidence of prostate cancer is almost 60 % higher and the mortality rate is two to three times greater than in Caucasians. The purpose of this study is to reduce African American men's prostate cancer burden by demonstrating they need separate screening guidelines. METHODS We performed a PubMed search using the keywords: African American, Prostate cancer, Outcomes, Molecular markers, Prostate-specific Antigen velocity, PSA density, and to derive data relevant to our hypothesis. RESULTS In our literature review, we identified several aspects of prostate cancer that are different in Caucasian and African American men. These included prostate cancer incidence and outcome, the clinical course of the disease, serum PSA levels, genetic differences, and social barriers. It's also important to note that the USPSTF guidelines were based on two studies, one of which reported that only 4 % of its participants were African American. The other did not report demographic information, but used participants from seven European countries with small African American populations. CONCLUSION Given the above, we conclude that separate prostate cancer screening guidelines are greatly necessary to help save the lives of African Americans.
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Affiliation(s)
- Divya Shenoy
- University of Mississippi Medical School, Jackson, MS, USA
| | | | - Allen M Chen
- University of California, Los Angeles-David Geffen School of Medicine, Los Angeles, California, USA
| | - Srinivasan Vijayakumar
- University of Mississippi Medical Center, 2500 North State Street, 39216-4505, Jackson, MS, USA.
- UMMC Cancer Institute, Department of Radiation Oncology, 2500 North State Street, 39216-4505, Jackson, MS, USA.
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