Patterns of Care for Medicare Beneficiaries With Metastatic Prostate Cancer

INTRODUCTION

Therapeutic options for men with metastatic prostate cancer have increased in the past decade. We studied recent treatment patterns for men with metastatic prostate cancer and how treatment patterns have changed over time.

METHODS

Using the Surveillance, Epidemiology, and End Results‒Medicare database, we identified fee-for-service Medicare beneficiaries who either were diagnosed with metastatic prostate cancer or developed metastases following diagnosis, as indicated by the presence of claims with diagnoses codes for metastatic disease, between 2007 and 2017. We evaluated treatment patterns using claims.

RESULTS

We identified 29,800 men with metastatic disease, of whom 4721 (18.8%) had metastatic disease at their initial diagnosis. The mean age was 77 years, and 77.9% of patients were non-Hispanic White. The proportion receiving antineoplastic agents within 3 years of the index date increased over time (from 9.7% in 2007 to 25.9% in 2017; P < .001). Opioid use within 3 years of prostate cancer diagnosis was stable during 2007 to 2013 (around 73%) but decreased through 2017 to 65.5% (P < .001). Patients diagnosed during 2015 to 2017 had longer median survival (32.6 months) compared to those diagnosed during 2007 to 2010 (26.6 months; P < .001).

CONCLUSIONS

Most metastatic prostate cancer patients do not receive life-prolonging antineoplastic therapies. Improved adoption of effective cancer therapies when appropriate may increase length and quality of survival among metastatic prostate cancer patients.

Health-related quality of life among prostate cancer survivors with metastatic disease and non-metastatic disease and men without a cancer history in the USA

BACKGROUND

Few studies have comprehensively compared health-related quality of life (HRQoL) between metastatic prostate cancer survivors, survivors with non-metastatic disease, and men without a cancer history.

METHODS

We used the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) data linkage to identify men aged ≥ 65 years enrolled in Medicare Advantage (MA) plans. Prostate cancer survivors were diagnosed between 1988 and 2017 and completed MHOS surveys between 1998 and 2019. We analyzed data from 752 metastatic prostate cancer survivors (1040 survey records), 19,583 localized or regional prostate cancer survivors (non-metastatic; 30,121 survey records), and 784,305 men aged ≥ 65 years without a cancer history in the same SEER regions (1.15 million survey records). We used clustered linear regressions to compare HRQoL measures at the person-level using the Veterans RAND 12 Item Health Survey (VR-12) T-scores for general health and physical and mental component summaries.

RESULTS

Compared to men without a cancer history, prostate cancer survivors were older, more likely to be married, and had higher socioeconomic status. Compared to men without a cancer history, metastatic prostate cancer survivors reported lower general health (T-score differences [95% confidence interval]: - 6.26, [- 7.14, - 5.38], p < .001), physical health (- 4.33, [- 5.18, - 3.48], p < .001), and mental health (- 2.64, [- 3.40, - 1.88], p < .001) component summaries. Results were similar for other VR-12 T-scores. In contrast, non-metastatic prostate cancer survivors reported similar VR-12 T-scores as men without a cancer history. Further analyses comparing metastatic and non-metastatic prostate cancer survivors support these findings.

CONCLUSION

Interventions to improve health-related quality of life for men diagnosed with metastatic prostate cancer merit additional investigation.

IMPLICATIONS FOR CANCER SURVIVORS

Interventions to improve health-related quality of life for metastatic prostate cancer survivors merit additional investigation.

The cost burden of metastatic prostate cancer in the US populations covered by employer-sponsored health insurance

BACKGROUND

Recent advancements in the clinical management of metastatic prostate cancer include several costly therapies and diagnostic tests. The objective of this study was to provide updated information on the cost to payers attributable to metastatic prostate cancer among men aged 18 to 64 years with employer-sponsored health plans and men aged 18 years or older covered by employer-sponsored Medicare supplement insurance.

METHODS

By using Merative MarketScan commercial and Medicare supplemental data for 2009-2019, the authors calculated differences in spending between men with metastatic prostate cancer and their matched, prostate cancer-free controls, adjusting for age, enrollment length, comorbidities, and inflation to 2019 US dollars.

RESULTS

The authors compared 9011 patients who had metastatic prostate cancer and were covered by commercial insurance plans with a group of 44,934 matched controls and also compared 17,899 patients who had metastatic prostate cancer and were covered by employer-sponsored Medicare supplement plans with a group of 87,884 matched controls. The mean age of patients with metastatic prostate cancer was 58.5 years in the commercial samples and 77.8 years in the Medicare supplement samples. Annual spending attributable to metastatic prostate cancer was $55,949 per person-year (95% confidence interval [CI], $54,074-$57,825 per person-year) in the commercial population and $43,682 per person-year (95% CI, $42,022-$45,342 per person-year) in the population covered by Medicare supplement plans, both in 2019 US dollars.

CONCLUSIONS

The cost burden attributable to metastatic prostate cancer exceeds $55,000 per person-year among men with employer-sponsored health insurance and $43,000 among those covered by employer-sponsored Medicare supplement plans. These estimates can improve the precision of value assessments of clinical and policy approaches to the prevention, screening, and treatment of prostate cancer in the United States.

Multilevel Small Area Estimation for County-Level Prevalence of Mammography Use in the United States Using 2018 Data

Background: The U.S. Preventive Services Task Force recommends biennial screening mammography for average-risk women aged 50-74 years. We aim to generate county-level prevalence estimates for mammography use to examine disparities among counties. Materials and Methods: We used data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 111,902 women) and linked them to county-level data from the American Community Survey. We defined two outcomes: mammography within the past 2 years (current); and mammography 5 or more years ago or never (rarely or never). We poststratified the data with U.S. Census estimated county population counts, ran Monte Carlo simulations, and generated county-level estimates. We aggregated estimates to state and national levels. We validated internal consistency between our model-based and BRFSS state estimates using Spearman and Pearson correlation coefficients. Results: Nationally, more than three in four women [78.7% (95% confidence interval {CI}: 78.2%-79.2%)] were current with mammography, although with large variations among counties. Also, nationally, about one in nine women [11% (95% CI: 10.8%-11.3%)] rarely or never had a mammogram. County estimates for being current ranged from 60.4% in New Mexico to 86.9% in Hawaii. Rarely or never having a mammogram ranged from 6% in Connecticut to 23.0% in Alaska, and on average, almost one in eight women in all the counties. Internal consistency correlation coefficient tests were ≥0.94. Conclusions: Our analyses identified marked county variations in mammography use across the country among women aged 50-74 years. We generated estimates for all counties, which may be helpful for targeted outreach to increase mammography uptake.

Use Trends and Recent Expenditures for Cervical Cancer Screening-Associated Services in Medicare Fee-for-Service Beneficiaries Older Than 65 Years

Importance

Since 1996, the US Preventive Services Task Force has recommended against cervical cancer screening in average-risk women 65 years or older with adequate prior screening. Little is known about the use of cervical cancer screening-associated services in this age group.

Objective

To examine annual use trends in cervical cancer screening-associated services, specifically cytology and human papillomavirus (HPV) tests, colposcopy, and cervical procedures (loop electrosurgical excision procedure, cone biopsy, and ablation) in Medicare fee-for-service beneficiaries during January 1, 1999, to December 31, 2019, and estimate expenditures for services performed in 2019.

Design, Setting, and Participants

This population-based, cross-sectional analysis included health service use data across 21 years for women aged 65 to 114 years with Medicare fee-for-service coverage (15-16 million women per year). Data analysis was conducted between July 2021 and April 2022.

Main Outcomes and Measures

Proportion of testing modalities (cytology alone, cytology plus HPV testing [cotesting], HPV testing alone); annual use rate per 100 000 women of cytology and HPV testing, colposcopy, and cervical procedures from 1999 to 2019; Medicare expenditure for these services in 2019.

Results

There were 15 323 635 women 65 years and older with Medicare fee-for-service coverage in 1999 and 15 298 656 in 2019. In 2019, the mean (SD) age of study population was 76.2 (8.1) years, 5.1% were Hispanic, 0.5% were non-Hispanic American Indian/Alaska Native, 3.0% were non-Hispanic Asian/Pacific Islander, 7.4% were non-Hispanic Black, and 82.0% were non-Hispanic White. From 1999 to 2019, the percentage of women who received at least 1 cytology or HPV test decreased from 18.9% (2.9 million women) in 1999 to 8.5% (1.3 million women) in 2019, a reduction of 55.3%; use rates of colposcopy and cervical procedures decreased 43.2% and 64.4%, respectively. Trend analyses showed a 4.6% average annual reduction in use of cytology or HPV testing during 1999 to 2019 (P < .001). Use rates of colposcopy and cervical procedures decreased before 2015 then plateaued during 2015 to 2019. The total Medicare expenditure for all services rendered in 2019 was about $83.5 million. About 3% of women older than 80 years received at least 1 service at a cost of $7.4 million in 2019.

Conclusions and Relevance

The results of this cross-sectional study suggest that while annual use of cervical cancer screening-associated services in the Medicare fee-for-service population older than 65 years has decreased during the last 2 decades, more than 1.3 million women received these services in 2019 at substantial costs.

Number of prostate-specific antigen (PSA) screening tests in the last five years reported by men in the United States in 2010, 2015, and 2018

BACKGROUND

Longer intervals between prostate-specific antigen (PSA) tests for routine prostate cancer screening can reduce the harms while maintaining the benefits of screening. Limited information has been published on PSA screening frequency. The purpose of this report is to describe the number of PSA tests in the last 5 years reported by men in the United States.

METHODS

Using data from National Health Interview Survey Cancer Control Supplements in 2010, 2015, and 2018, the number of PSA tests in the last 5 years reported by men ≥40 years was categorized as 4 to 5 PSA tests, 1 to 3 PSA tests, and no PSA tests. Logistic regression was used to calculate model-adjusted prevalence risk ratios (aPRs) for the number of PSA tests in the last 5 years, adjusting for age, racial-ethnic group, education, marital status, and health insurance.

RESULTS

The proportion of men aged ≥70 years who reported 4 to 5 PSA tests in the last 5 years decreased from 37.2% in 2010 to 31.1% in 2018, while the proportion reporting 1 to 3 PSA tests increased from 25.5% to 31.9%. In 2018, aPRs for 4 to 5 PSA tests vs. 1 to 3 PSA tests in the last 5 years were significantly higher among men aged 70 to 79 years than among men aged 55 to 69 years.

CONCLUSIONS

Men aged ≥70 years reported a small shift to less intense PSA testing between 2010 and 2018, but PSA testing intensity remained higher in men aged ≥70 years than in men aged 55 to 69 years.

Computable Guidelines and Clinical Decision Support for Cervical Cancer Screening and Management to Improve Outcomes and Health Equity

Cervical cancer is highly preventable when precancerous lesions are detected early and appropriately managed. However, the complexity of and frequent updates to existing evidence-based clinical guidelines make it challenging for clinicians to stay abreast of the latest recommendations. In addition, limited availability and accessibility to information technology (IT) decision supports make it difficult for groups who are medically underserved to receive screening or receive the appropriate follow-up care. The Centers for Disease Control and Prevention (CDC), Division of Cancer Prevention and Control (DCPC), is leading a multiyear initiative to develop computer-interpretable ("computable") version of already existing evidence-based guidelines to support clinician awareness and adoption of the most up-to-date cervical cancer screening and management guidelines. DCPC is collaborating with the MITRE Corporation, leading scientists from the National Cancer Institute, and other CDC subject matter experts to translate existing narrative guidelines into computable format and develop clinical decision support tools for integration into health IT systems such as electronic health records with the ultimate goal of improving patient outcomes and decreasing disparities in cervical cancer outcomes among populations that are medically underserved. This initiative meets the challenges and opportunities highlighted by the President's Cancer Panel and the President's Cancer Moonshot 2.0 to nearly eliminate cervical cancer.

The use of electronic health records to inform cancer surveillance efforts: a scoping review and test of indicators for public health surveillance of cancer prevention and control

INTRODUCTION

State cancer prevention and control programs rely on public health surveillance data to set objectives to improve cancer prevention and control, plan interventions, and evaluate state-level progress towards achieving those objectives. The goal of this project was to evaluate the validity of using electronic health records (EHRs) based on common data model variables to generate indicators for surveillance of cancer prevention and control for these public health programs.

METHODS

Following the methodological guidance from the PRISMA Extension for Scoping Reviews, we conducted a literature scoping review to assess how EHRs are used to inform cancer surveillance. We then developed 26 indicators along the continuum of the cascade of care, including cancer risk factors, immunizations to prevent cancer, cancer screenings, quality of initial care after abnormal screening results, and cancer burden. Indicators were calculated within a sample of patients from the New York City (NYC) INSIGHT Clinical Research Network using common data model EHR data and were weighted to the NYC population using post-stratification. We used prevalence ratios to compare these estimates to estimates from the raw EHR of NYU Langone Health to assess quality of information within INSIGHT, and we compared estimates to results from existing surveillance sources to assess validity.

RESULTS

Of the 401 identified articles, 15% had a study purpose related to surveillance. Our indicator comparisons found that INSIGHT EHR-based measures for risk factor indicators were similar to estimates from external sources. In contrast, cancer screening and vaccination indicators were substantially underestimated as compared to estimates from external sources. Cancer screenings and vaccinations were often recorded in sections of the EHR that were not captured by the common data model. INSIGHT estimates for many quality-of-care indicators were higher than those calculated using a raw EHR.

CONCLUSION

Common data model EHR data can provide rich information for certain indicators related to the cascade of care but may have substantial biases for others that limit their use in informing surveillance efforts for cancer prevention and control programs.

Multilevel small area estimation for county-level prevalence of colorectal cancer screening test use in the United States using 2018 data

PURPOSE-

National screening estimates mask county-level variations. We aimed to generate county-level colorectal cancer (CRC) screening prevalence estimates for 2018 among adults aged 50-75 years and identify counties with low screening prevalence.

METHODS-

We combined individual-level county data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 204,947) with the 2018 American Community Survey county poverty data as a covariate, and the 2018 U.S. Census county population count data to generate county-level prevalence estimates for being current with any CRC screening test, colonoscopy, and home stool blood test. Because BRFSS is a state-based survey, and because some counties did not have samples for analysis, we used correlation coefficients to test internal consistency between model-based and BRFSS state estimates.

RESULTS-

Correlation coefficients tests were ≥0.97. Model-based national prevalence for any test was 69.9% (95% CI, 69.5% -70.4%) suggesting 30% are not current with screening test use. State mean estimates ranged from 62.1% in Alaska and Wyoming to 76.6% in Maine and Massachusetts. County mean estimates ranged from 42.2% in Alaska to 80.0% in Florida and Rhode Island. Most tests were performed with colonoscopy.

CONCLUSIONS-

Estimates across all U.S. counties showed large variations. Estimates may be informative for planning by states and local screening programs.

Prostate Cancer Incidence and Survival, by Stage and Race/Ethnicity - United States, 2001-2017

Among U.S. men, prostate cancer is the second leading cause of cancer-related death (1). Past studies documented decreasing incidence of prostate cancer overall since 2000 but increasing incidence of distant stage prostate cancer (i.e., signifying spread to parts of the body remote from the primary tumor) starting in 2010 (2,3). Past studies described disparities in prostate cancer survival by stage, age, and race/ethnicity using data covering ≤80% of the U.S. population (4,5). To provide recent data on incidence and survival of prostate cancer in the United States, CDC analyzed data from population-based cancer registries that contribute to U.S. Cancer Statistics (USCS).* Among 3.1 million new cases of prostate cancer recorded during 2003-2017, localized, regional, distant, and unknown stage prostate cancer accounted for 77%, 11%, 5%, and 7% of cases, respectively, but the incidence of distant stage prostate cancer significantly increased during 2010-2017. During 2001-2016, 10-year relative survival for localized stage prostate cancer was 100%. Overall, 5-year survival for distant stage prostate cancer improved from 28.7% during 2001-2005 to 32.3% during 2011-2016; for the period 2001-2016, 5-year survival was highest among Asian/Pacific Islanders (API) (42.0%), followed by Hispanics (37.2%), American Indian/Alaska Natives (AI/AN) (32.2%), Black men (31.6%), and White men (29.1%). Understanding incidence and survival differences by stage, race/ethnicity, and age can guide public health planning related to screening, treatment, and survivor care. Future research into differences by stage, race/ethnicity, and age could inform interventions aimed at improving disparities in outcomes.

Abstract B023: Racial-ethnic disparities in the receipt of initial, cure-intended treatment for localized prostate cancer, SEER Medicare, 2004-2013

Purpose: We sought to determine if there were racial/ethnic disparities in the receipt of initial, cure-intended treatment for localized prostate cancer.

Methods: We analyzed prostate cancer cases reported in 2004-2013 to Surveillance, Epidemiology and End Results (SEER) cancer registries, linked with Medicare claims from 2003-2014. We focused on cases that were fee-for-service with continuous Part A and B Medicare from 12 months before first diagnosis to 6 months after diagnosis, and that had American Joint Committee on Cancer 6th Edition tumor extent T1 or T2 without metastatic disease. We used SEER race/ethnicity to categorize cases as non-Hispanic whites; non-Hispanic blacks; non-Hispanic Asian or Pacific Islanders; Hispanics of any race; and Other/Unknown. We defined initial treatment to include 1 month before to 6 months after first diagnosis; cure-intended radical prostatectomy to include radical prostatectomy with or without radiation therapy; cure-intended radiation therapy to include radiation therapy without a radical prostatectomy; and noncurative treatment to include other initial treatment or no treatment. We used multivariable logistic regression to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for receipt of each category of initial treatment, compared with the remaining cases, and adjusting for race/ethnicity; life expectancy from the man's age at diagnosis; pretreatment prostate cancer disease recurrence risk category; Charlson comorbidity score; year of diagnosis; SEER registry region, census tract poverty; and metropolitan or nonmetropolitan county location.

Results: Our final study cohort included a total of 125,072 men, with 95,763 non-Hispanic white, 13,616 non-Hispanic black, 4,658 non-Hispanic Asian or Pacific Islanders, 7,933 Hispanic any race, and 3,102 in the Other/Unknown category. After adjustment for multiple variables, non-Hispanic blacks were less likely than non-Hispanic whites to receive initial radical prostatectomy (with or without radiation therapy) (OR, 0.57; 95% CI, 0.53-0.61) or initial radiation therapy without radical prostatectomy (OR, 0.85; 95% CI, 0.82-0.88), and more likely to receive noncurative treatment (OR, 1.51; 95% CI, 1.45-1.57). Non-Hispanic Asian or Pacific Islanders were more likely than non-Hispanic whites to receive initial radiation therapy without radical prostatectomy (OR, 1.23; 95% CI, 1.16-1.31), and less likely to receive noncurative treatment (OR, 0.84; 95% CI, 0.78-0.89). The adjusted odds ratios for curative and noncurative initial treatment received by Hispanics of any race were similar to those for non-Hispanic whites.

Conclusion: Compared with non-Hispanic whites, non-Hispanic black men were less likely to receive curative and more likely to receive noncurative initial treatment for localized prostate cancer during 2004-2013.

Citation Format: Thomas B. Richards, David G. Stinchcomb, Timothy S. McNeel, Wilhelmina Ross, Diane Ng. Racial-ethnic disparities in the receipt of initial, cure-intended treatment for localized prostate cancer, SEER Medicare, 2004-2013 [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 B023.

Prostate cancer relative survival by stage and race/ethnicity, United States, 2001 to 2015

5509

Background: Prostate cancer is the most common cancer diagnosed and the second leading cause of cancer-related deaths among U.S. men. Incidence rates for distant stage cancer increased during 2010–2014, and survival at all stages was lower for black men than white men. We examined temporal changes in survival by race/ethnicity. Methods: Five-year relative survival (RS) (cancer survival in the absence of other causes of death) was calculated for men with prostate cancer aged ≥40 years using National Program of Cancer Registries data (93% U.S. population coverage). Cancers were diagnosed during 2001–2015 with follow-up through 2015. RS was estimated by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic), stage, and year (2001–2007 and 2008–2015). Differences were determined by non-overlapping 95% confidence intervals (CI). Results: During 2001–2015, 2,234,233 cases were recorded. Five-year RS was 100% for localized disease in all race/ethnicities and time periods. Overall, RS improved from 29.0% (95% CI, 28.5–29.5) to 31.3% (30.8–31.9) for distant stage and 83.4% (83.0–83.8) to 84.7% (84.2–85.1) for unknown stage. For regional stage, RS improved for white men (table). For distant stage, RS was highest for black and Hispanic men. For unknown stage, RS was highest for white and Hispanic men. Conclusions: RS improved for regional, distant, and unknown stage, but disparities by race/ethnicity persist. The disparity between black and white men for distant stage reversed compared to past studies. Further investigation of diagnosis patterns and clinical characteristics of men with distant and unknown stage cancer could inform interventions to address disparities in outcomes. [Table: see text]

Screening for Lung Cancer - 10 States, 2017

Lung cancer is the leading cause of cancer death in the United States; 148,869 lung cancer-associated deaths occurred in 2016 (1). Mortality might be reduced by identifying lung cancer at an early stage when treatment can be more effective (2). In 2013, the U.S. Preventive Services Task Force (USPSTF) recommended annual screening for lung cancer with low-dose computed tomography (CT) for adults aged 55-80 years who have a 30 pack-year* smoking history and currently smoke or have quit within the past 15 years (2).^† This was a Grade B recommendation, which required health insurance plans to cover lung cancer screening as a preventive service.^§ To assess the prevalence of lung cancer screening by state, CDC used Behavioral Risk Factor Surveillance System (BRFSS) data^¶ collected in 2017 by 10 states.** Overall, 12.7% adults aged 55-80 years met the USPSTF criteria for lung cancer screening. Among those meeting USPSTF criteria, 12.5% reported they had received a CT scan to check for lung cancer in the last 12 months. Efforts to educate health care providers and provide decision support tools might increase recommended lung cancer screening.

Utilization and Cost of Mammography Screening Among Commercially Insured Women 50 to 64 Years of Age in the United States, 2012-2016

Background: In recent years, most insurance plans eliminated cost-sharing for breast cancer screening and recommended screening intervals changed, and newer modalities-digital mammography and breast tomosynthesis-became more widely available. The objectives of this study are to examine how these changes affected utilization, frequency, and costs of breast cancer screening among commercially insured women, and to understand factors associated with utilization and frequency of screening. Materials and Methods: This study used commercial insurance claims data for women 50 to 64 years of age, continuously enrolled in commercial insurance plans during 2012-2016. Results: Of the 685,737 eligible women, 20% were not screened, 40% received annual screening, 24% received biennial screening, and 16% were screened less frequently than recommended during the time period examined. Sociodemographic factors such as age <60 years, rurality, and fee-for-service insurance were associated with low screening utilization. Patients who received annual screening incurred ∼1.78 times higher costs compared to those who received biennial screening during the study period. Digital mammography was the most costly and commonly used modality along with computer-aided detection. Conclusions: Evidence-based interventions to promote screening among women who are screened less frequently are needed along with interventions to move toward biennial screening rather than annual screening. Increasing provider awareness regarding breast cancer screening rates and frequency among various sociodemographic groups is essential to guide provider recommendations and shared decision making. The results of this study can guide targeted public health interventions to reduce barriers to screening, and can also serve as inputs for economic analyses of screening interventions and programs.

Lung Cancer Screening Inconsistent With U.S. Preventive Services Task Force Recommendations

INTRODUCTION

Prior studies suggest overuse of nonrecommended lung cancer screening tests in U.S. community practice and underuse of recommended tests.

METHODS

Data from the 2010 and 2015 National Health Interview Surveys was analyzed from 2016 to 2018. Prevalence, populations, and number of chest computed tomography (CT) and chest x-ray tests were estimated for people who did and did not meet U.S. Preventive Services Task Force (USPSTF) criteria for lung cancer screening, among people aged ≥40 years without lung cancer.

RESULTS

In 2015, among those who met USPSTF criteria, 4.4% (95% CI=3.0%, 6.6%), or 360,000 (95% CI=240,000, 535,000) people reported lung cancer screening with a chest CT; and 8.5% (95% CI=6.5%, 11.1%), or 689,000 (95% CI=526,000, 898,000) people reported a chest x ray. Among those who did not meet USPSTF criteria, 2.3% (95% CI=2.0%, 2.6%), or 3,259,000 (95% CI=2,850,000, 3,724,000) people reported a chest x ray; and 1.3% (95% CI=1.1%, 1.5%), or 1,806,000 (95% CI=1,495,000, 2,173,000) people reported a chest CT. The estimated population meeting USPSTF criteria for lung cancer screening in 2015 was 8,098,000 (95% CI=7,533,000, 8,702,000), which was smaller than the 9,620,000 people (95% CI=8,960,000, 10,325,000) in 2010.

CONCLUSIONS

The number of adults inappropriately screened for lung cancer greatly exceeds the number screened according to USPSTF recommendations, the prevalence of appropriate lung cancer screening is low, and the population meeting USPSTF criteria is shrinking. To realize the potential benefits of screening, better processes to appropriately triage eligible individuals to screening, plus screening with a USPSTF-recommended test, would be beneficial.

Lung Cancer Among Women in the United States

November marks Lung Cancer Awareness Month, and reminds us that lung cancer is the leading cause of cancer death among women in the United States. In this brief report, we highlight CDC resources that can be used to examine the most recent data on lung cancer incidence, survival, prevalence, and mortality among women. Using the U.S. Cancer Statistics Data Visualizations tool, we report that in 2015, 104,992 new cases of lung cancer and 70,073 lung cancer deaths were reported among women in the United States. The 5-year relative survival among females diagnosed with lung cancer was 22%, and as of 2015, ∼185,759 women were living with a lung cancer diagnosis. We also describe ways CDC works to collect and disseminate quality cancer surveillance data, prevent initiation of tobacco use, promote cessation, eliminate exposure to secondhand smoke, identify and eliminate disparities, promote lung cancer screening, and help cancer survivors live longer by improving health outcomes.

Multilevel Regression for Small-Area Estimation of Mammography Use in the United States, 2014

BACKGROUND

The U.S. Preventive Services Task Force recommends biennial screening mammography for average-risk women aged 50-74 years. County-level information on population measures of mammography use can inform targeted intervention to reduce geographic disparities in mammography use. County-level estimates for mammography use nationwide are rarely presented.

METHODS

We used data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS; n = 130,289 women), linked it to the American Community Survey poverty data, and fitted multilevel logistic regression models with two outcomes: mammography within the past 2 years (up-to-date), and most recent mammography 5 or more years ago or never (rarely/never). We poststratified the data with U.S. Census population counts to run Monte Carlo simulations. We generated county-level estimates nationally and by urban-rural county classifications. County-level prevalence estimates were aggregated into state and national estimates. We validated internal consistency between our model-based state-specific estimates and urban-rural estimates with BRFSS direct estimates using Spearman correlation coefficients and mean absolute differences.

RESULTS

Correlation coefficients were 0.94 or larger. Mean absolute differences for the two outcomes ranged from 0.79 to 1.03. Although 78.45% (95% confidence interval, 77.95%-78.92%) of women nationally were up-to-date with mammography, more than half of the states had counties with >15% of women rarely/never using a mammogram, many in rural areas.

CONCLUSIONS

We provided estimates for all U.S. counties and identified marked variations in mammography use. Many states and counties were far from the 2020 target (81.1%).

IMPACT

Our results suggest a need for planning and resource allocation on a local level to increase mammography uptake.

Multilevel Small-Area Estimation of Colorectal Cancer Screening in the United States

Background: The U.S. Preventive Services Task Force recommends routine screening for colorectal cancer for adults ages 50 to 75 years. We generated small-area estimates for being current with colorectal cancer screening to examine sociogeographic differences among states and counties. To our knowledge, nationwide county-level estimates for colorectal cancer screening are rarely presented.Methods: We used county data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS; n = 251,360 adults), linked it to the American Community Survey poverty data, and fitted multilevel logistic regression models. We post-stratified the data with the U.S. Census population data to run Monte Carlo simulations. We generated county-level screening prevalence estimates nationally and by race/ethnicity, mapped the estimates, and aggregated them into state and national estimates. We evaluated internal consistency of our modeled state-specific estimates with BRFSS direct state estimates using Spearman correlation coefficients.Results: Correlation coefficients were ≥0.95, indicating high internal consistency. We observed substantial variations in current colorectal cancer screening estimates among the states and counties within states. State mean estimates ranged from 58.92% in Wyoming to 75.03% in Massachusetts. County mean estimates ranged from 40.11% in Alaska to 79.76% in Florida. Larger county variations were observed in various race/ethnicity groups.Conclusions: State estimates mask county variations. However, both state and county estimates indicate that the country is far behind the "80% by 2018" target.Impact: County-modeled estimates help identify variation in colorectal cancer screening prevalence in the United States and guide education and enhanced screening efforts in areas of need, including areas without BRFSS direct-estimates. Cancer Epidemiol Biomarkers Prev; 27(3); 245-53. ©2018 AACR.

Multilevel Small-Area Estimation of Multiple Cigarette Smoking Status Categories Using the 2012 Behavioral Risk Factor Surveillance System

BACKGROUND

Smoking is the leading preventable cause of death; however, small-area estimates for detailed smoking status are limited. We developed multilevel small-area estimate mixed models to generate county-level estimates for six smoking status categories: current, some days, every day, former, ever, and never.

METHOD

Using 2012 Behavioral Risk Factor Surveillance System (BRFSS) data (our sample size = 405,233 persons), we constructed and fitted a series of multilevel logistic regression models and applied them to the U.S. Census population to generate county-level prevalence estimates. We mapped the estimates by sex and aggregated them into state and national estimates. We conducted comparisons for internal consistency with BRFSS states' estimates using Pearson correlation coefficients, and external validation with the 2012 National Health Interview Survey current smoking prevalence.

RESULTS

Correlation coefficients ranged from 0.908 to 0.982, indicating high internal consistency. External validation indicated complete agreement (prevalence = 18.06%). We found large variations in current and former smoking status between and within states and by sex. County prevalence of former smokers was highest among men in the Northeast, North, and West. Utah consistently had the lowest smoking prevalence.

CONCLUSIONS

Our models, which include demographic and geographic characteristics, provide reliable estimates that can be applied to multiple category outcomes and any demographic group. County and state estimates may help understand the variation in smoking prevalence in the United States and provide information for control and prevention.

IMPACT

Detailed county and state smoking category estimates can help identify areas in need of tobacco control and prevention and potentially allow planning for health care. Cancer Epidemiol Biomarkers Prev; 25(10); 1402-10. ©2016 AACR.

Lung cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study

BACKGROUND

Results from the second CONCORD study (CONCORD-2) indicated that 5-year net survival for lung cancer was low (range, 10%-20%) between 1995 and 2009 in most countries, including the United States, which was at the higher end of this range.

METHODS

Data from CONCORD-2 were used to analyze net survival among patients with lung cancer (aged 15-99 years) who were diagnosed in 37 states covering 80% of the US population. Survival was corrected for background mortality using state-specific and race-specific life tables and age-standardized using International Cancer Survival Standard weights. Net survival was estimated for patients diagnosed between 2001 and 2003 and between 2004 and 2009 at 1, 3, and 5 years after diagnosis by race (all races, black, and white); Surveillance, Epidemiology, and End Results Summary Stage 2000; and US state.

RESULTS

Five-year net survival increased from 16.4% (95% confidence interval, 16.3%-16.5%) for patients diagnosed 2001-2003 to 19.0% (18.8%-19.1%) for those diagnosed 2004-2009, with increases in most states and among both blacks and whites. Between 2004 and 2009, 5-year survival was lower among blacks (14.9%) than among whites (19.4%) and ranged by state from 14.5% to 25.2%.

CONCLUSIONS

Lung cancer survival improved slightly between the periods 2001-2003 and 2004-2009 but was still low, with variation between states, and persistently lower survival among blacks than whites. Efforts to control well established risk factors would be expected to have the greatest impact on reducing the burden of lung cancer, and efforts to ensure that all patients receive timely and appropriate treatment should reduce the differences in survival by race and state. Cancer 2017;123:5079-99. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Patterns of Prostate-Specific Antigen Test Use in the U.S., 2005-2015

INTRODUCTION

Recommendations for prostate-specific antigen-based screening for prostate cancer are placing increasing emphasis on men aged 55-69 years. The goal of the current study is to describe patterns of population-based prostate-specific antigen testing with details about that age group.

METHODS

National Health Interview Surveys from 2005 to 2015 were analyzed in 2017 to estimate routine prostate-specific antigen testing in the past year from self-reported data by age group (40-54, 55-69, ≥70 years), and also by risk group, defined as African American men or men with a family history of prostate cancer versus other men. Differences between successive survey years by age and risk groups were assessed by predicted margins and rate ratios with 99% CIs, using logistic regressions.

RESULTS

Prostate-specific antigen testing among men aged 55-69 years decreased from a high of 43.1% (95% CI=40.3, 46.1) in 2008 to a low of 32.8% (95% CI=30.8, 34.7) in 2013, with no significant change in 2015 at 33.8% (95% CI=31.3, 36.4). Men aged ≥70 years had consistently high prevalence in all survey years, ranging from 51.1% in 2008 to 36.4% in 2015. African American men, men with a family history of prostate cancer, and other men showed a 5% absolute decrease over time, but this reduction was significant only in other men.

CONCLUSIONS

Despite decreases, the absolute change in prostate-specific antigen testing for men aged 55-69 years was small (9.3%) over the study period. Men aged ≥70 years, for whom the benefits are unlikely to exceed the harms, continue to have consistently high testing prevalence.

A qualitative analysis of smokers' perceptions about lung cancer screening

Background

In 2013, the US Preventive Services Task Force (USPSTF) began recommending lung cancer screening for high risk smokers aged 55–80 years using low-dose computed tomography (CT) scan. In light of these updated recommendations, there is a need to understand smokers’ knowledge of and experiences with lung cancer screening in order to inform the design of patient education and tobacco cessation programs. The purpose of this study is to describe results of a qualitative study examining smokers’ perceptions around lung cancer screening tests.

Methods

In 2009, prior to the release of the updated USPSTF recommendations, we conducted 12 120-min, gender-specific focus groups with 105 current smokers in Charlotte, North Carolina and Cincinnati, Ohio. Focus group facilitators asked participants about their experience with three lung cancer screening tests, including CT scan, chest x-ray, and sputum cytology. Focus group transcripts were transcribed and qualitatively analyzed using constant comparative methods.

Results

Participants were 41–67 years-old, with a mean smoking history of 38.9 pack-years. Overall, 34.3% would meet the USPSTF’s current eligibility criteria for screening. Most participants were unaware of all three lung cancer screening tests. The few participants who had been screened recalled limited information about the test. Nevertheless, many participants expressed a strong desire to pursue lung cancer screening. Using the social ecological model for health promotion, we identified potential barriers to lung cancer screening at the 1) health care system level (cost of procedure, confusion around results), 2) cultural level (fatalistic beliefs, distrust of medical system), and 3) individual level (lack of knowledge, denial of risk, concerns about the procedure). Although this study was conducted prior to the updated USPSTF recommendations, these findings provide a baseline for future studies examining smokers’ perceptions of lung cancer screening.

Conclusion

We recommend clear and patient-friendly educational tools to improve patient understanding of screening risks and benefits and the use of best practices to help smokers quit. Further qualitative studies are needed to assess changes in smokers’ perceptions as lung cancer screening with CT scan becomes more widely used in community practice.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4496-0) contains supplementary material, which is available to authorized users.

Abstract B29: Trends in racial disparities in five-year net survival for lung cancer, United States, 2001-2009

Background: Net survival adjusts for age and other causes of death (background mortality).The CONCORD-2 study reported net survival data on cancer patients in 67 countries, including the United States. The purpose of this analysis is to describe lung cancer net survival by race and stage among 37 participating states covering approximately 80% of the US population.

Methods: We focused on adults (15-99 years) diagnosed 2001-09 with an invasive, primary cancer of the lung and bronchus (International Classification of Disease Oncology 3rd edition topography codes: C34.0-C34.3; C34.8-C34.9) and followed up to 31 December 2009. We categorized stage at diagnosis using Surveillance Epidemiology and End Results (SEER) Summary Stage (SS) 2000. We analyzed two calendar periods (2001-03 and 2004-09) because of changes in the way summary stage data was collected during these time periods in the United States. We estimated the percent five-year net survival with 95% confidence intervals (CI) using the cohort approach for patients diagnosed in 2001-03 and the complete approach for patients diagnosed during 2004-09. We utilized bar-charts and funnel plots to graphically present trends, geographic variations, and differences in survival by race between 2001-03 and 2004-09.

Results: Our study included 1,404,724 invasive, primary lung cancers. US five-year net survival for all races increased from 16.4% (95% CI: 16.3%-16.5%) in 2001-03 to 19.0% (95% CI: 18.8%-19.1%) in 2004-09. Between the two calendar periods, most states also showed a small increase in five-year net survival for lung cancer. The increase was more than 2.6% (the US increase) in most states in the Northeast, but less than 2.6% in many states in the South, Midwest, and West. During 2004-09, blacks had lower percent five-year net survival than whites for the following stage categories: all stages [blacks (14.9%; 95% CI: 14.5%-15.2%) versus whites (19.4%; 95% CI: 19.2%-19.5%)]; localized [blacks (45.9%; 95% CI: 44.4%-47.4%) versus whites (55.8%; 95% CI: 55.3%-56.2%)]; regional [blacks (22.0%; 95% CI: 21.0%-23.0%) versus whites (26.7%; 95% CI: 26.4%-27.0%); and unknown [blacks (11.0%; 95% CI: 10.0%-12.1%) versus whites (14.0%; 95% CI: 13.5%-14.5%)]. Blacks and whites had similar percent five-year net survival for distant stage [blacks (4.4%; 95% CI: 4.1%-4.7%) versus whites (4.7%; 95% CI: 4.6%-4.8%).

Conclusions: Lung cancer net survival is lower in blacks than in whites. Although the US overall and many states showed a small increase in the percent net survival from 2001-03 to 2004-09, the five-year net survival for lung cancer 2004-09 is much lower than for other common cancers. Only 46% of black patients and 56% of white patients diagnosed with local stage lung cancer survive five years.

Citation Format: Thomas B. Richards, S Jane Henley, Mary C. Puckett, Hannah K. Weir, Bin Huang, Thomas C. Tucker. Trends in racial disparities in five-year net survival for lung cancer, United States, 2001-2009. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B29.

Abstract PR06: Racial-ethnic disparities in receipt of anatomic pulmonary resection in non-small cell lung cancer, SEER Medicare, 2000-2011

Purpose: Anatomic pulmonary resection includes surgical procedures such as pneumonectomy, lobectomy, and segmentectomy, in contrast to non-anatomic pulmonary surgical procedures such as wedge resection. National Comprehensive Cancer Network guidelines for non-small cell lung cancer (NSCLC) indicate that anatomic pulmonary resection is preferred when surgery is indicated. The purpose of the current study is to describe racial-ethnic disparities in the receipt of anatomic pulmonary resection among NSCLC patients.

Methods: We analyzed Surveillance, Epidemiology, and End Results (SEER) patients linked with Medicare claims, first diagnosed in 2000-2011. We required patients to have NSCLC as their first malignancy and covered by fee-for-service with continuous Part A and B Medicare from 12 months before to 4 months after first diagnosis. We categorized stage using American Joint Committee on Cancer 6th Edition. We excluded patients who were age ≤65 years; diagnosed at occult stage or stage 0; diagnosed at death; had unknown race, census tract poverty, urban-rural status, month of diagnosis, or month of death; or were enrolled in a health maintenance organization at any time from 12 months before to 4 months after diagnosis. We used SEER race to classify cases as: non-Hispanic whites; non-Hispanic blacks; Hispanics of white or black race (hereafter referred to as Hispanics), and Asian or Pacific Islanders. We reserved cases with American Indian or Alaska Native race for a future, separate analysis because numbers were smaller compared to other racial-ethnic groups. We defined anatomic pulmonary resection to include pneumonectomy, lobectomy, and segmentectomy. We identified receipt of anatomic pulmonary resection from the month of diagnosis to 4 months after first NSCLC diagnosis using Healthcare Common Procedure Coding System and International Classification of Disease 9th edition Clinical Modification codes. We used multiple variable logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for receipt of anatomic pulmonary resection by males, and separately by females, adjusting for age at diagnosis, racial-ethnic group, mediastinal exploration, stage, histology, census tract poverty, SEER region, year of diagnosis, and comorbidity.

Results: Our study cohort included 99,766 NSCLC cases, with similar proportions of males (51.2%) and females (48.8%). Overall, 23.2% (n=23,105) received anatomic pulmonary resection, but receipt varied by racial-ethnic group. Compared to non-Hispanic black men, anatomic resection procedures were more commonly received by men who were non-Hispanic white (aOR, 1.93; 95% CI, 1.70-2.19), Hispanic (aOR, 1.82; 95% CI, 1.49-2.22), or Asian or Pacific Islander (aOR, 2.06; 95% CI, 1.71-2.49). Compared to non-Hispanic black females, anatomic resection procedures also were more commonly received by females who were non-Hispanic white (aOR, 1.39; 95% CI, 1.23-1.57), Hispanic (aOR, 1.46; 95% CI, 1.20-1.79) or Asian or Pacific Islander (aOR, 1.42; 95% CI, 1.16-1.73).

Conclusions: Non-Hispanic black men diagnosed with NSCLC from 2000-2011 were less likely to receive anatomic pulmonary resection than non-Hispanic white, Hispanic, or Asian or Pacific Islander men. Non-Hispanic black females also were less likely to receive anatomic pulmonary resection, but the differences in aORs by race were smaller among females than among males.

Citation Format: Thomas B. Richards, Serban Negoita, Timothy S. McNeel, Dylan L. Holt, Marie Topor, S Jane Henley, Arica White, Jun Li, Chunyu Li. Racial-ethnic disparities in receipt of anatomic pulmonary resection in non-small cell lung cancer, SEER Medicare, 2000-2011. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR06.

Racial and Ethnic Differences in Health Behaviors and Preventive Health Services Among Prostate Cancer Survivors in the United States

Introduction

Little is known about how health behaviors and receipt of preventive health care differ by race and ethnicity among prostate cancer survivors. The purpose of this study was to identify differences in the prevalence of 7 modifiable factors related to prostate cancer: smoking, alcohol consumption, physical inactivity, weight, colorectal cancer screening, influenza vaccination, and pneumococcal vaccination.

Methods

We used data from the 2010 Behavioral Risk Factor Surveillance System to calculate the racial/ethnic prevalence of sociodemographic and health-related characteristics, health behaviors, and preventive health care among prostate cancer survivors. Adjusted prevalence estimates were calculated by using multivariable logistic regression.

Results

We identified 8,016 men with a history of prostate cancer. Multivariable analyses indicated that more black men reported being obese (29.9%; 95% confidence interval [CI], 24.5%–35.9%) than white men (22.8%; 95% CI, 21.1%–24.6%). More white men (3.6%; 95% CI, 2.9%–4.5%) reported consuming more than 2 alcoholic drinks per day than black men (0.9%; 95% CI, 0.4%–2.0%). More white men aged 65 or older reported receiving pneumococcal vaccine (74.2%; 95% CI, 72.2%–76.1%) than black men of the same age (63.2%; 95% CI, 54.8%–70.8%).We did not observe any differences in the prevalence of health behaviors and preventive health care between white men and men in Hispanic or other race categories.

Conclusion

Differences in alcohol consumption, obesity, and receipt of pneumococcal vaccination existed only between black and white prostate cancer survivors. These differences underscore the need to develop culturally appropriate, evidence-based interventions to reduce excessive alcohol consumption, maintain a healthy weight, and promote pneumococcal vaccination among prostate cancer survivors.

Abstract B44: Adjusted American Joint Committee on Cancer 6th edition stage for analysis of trends in black-white disparities in non-small cell lung cancer, SEER Medicare, 2000-2011

Purpose: Analyses of racial disparities in survival and treatment trends may be confounded by changes over time in cancer staging systems. For Surveillance, Epidemiology, and End Results (SEER) data linked with Medicare claims, non-small cell lung cancer (NSCLC) is available with American Joint Committee on Cancer (AJCC) 3rd edition stage from 2000–2003, and with AJCC 6th edition (AJCC6) stage from 2004–2011. We wanted to maximize the number of years that AJCC6 stage was available for analysis of trends. In this study, we describe the results of our methods to assign all NSCLC cases from 2000–2011 with stage group equivalent to AJCC6, and our assessment of black-white differences by stage and year following the stage reclassification.

Methods: We focused on SEER-Medicare linked NSCLS cases, diagnosed 2000–2011, enrolled in Medicare during the month of diagnosis, and with SEER race coded as white or black. We used SEER Extent of Disease 1988 (10 digit) codes to assign AJCC6 to cases diagnosed 2000–2003, Collaborative Stage version 1 to assign AJCC6 to cases diagnosed 2004–2009, and Collaborative Stage version 2 to assign AJCC6 to cases diagnosed 2010–2011. To evaluate our adjusted AJCC6, we calculated the percentage point (pp) differences in the proportions of cases by stage and race between 2003 and 2004, and also for the 2000–2003, 2004–2009, and 2010–2011 sub-cohorts. In addition, we used SEER Joinpoint regression analysis to calculate annual percentage change (APC) by stage and race, including coincident and parallel pairwise comparisons by race. We defined statistical significance as p&lt;0.05.

Results: Our final study cohort included 156,125 white and 16,594 black NSCLC cases. Overall from 2000 to 2011, the proportion of cases by stage was: IA (12.4%), IB (11.8%), IIA (1.2%), IIB (4.5%), IIIA (9.9%), IIIB (18.0%), and IV (41.0%); the remaining 1.2% were categorized Occult Carcinoma or Stage 0. The mean difference in proportions for stages I to IV between 2003 and 2004 was 0.3 pp, but the difference by specific stage varied up to 4.1 pp. The proportion Stage IA was higher in whites than in blacks (3.1 pp in 2000–2003; 3.7 pp in 2004–2009; and 3.5 pp in 2010–2011). The proportion Stage IV was higher in blacks than in whites (2.6 pp in 2000–2003; 3.2 pp in 2004–2009; and 3.5 pp in 2010–2011). Differences in proportions between whites and blacks for Stage IIA, IIB, and Stage IIIA were less than 1 pp for each of the three time periods. Proportions by stage for whites were greater than those for blacks for Stage IA to Stage IIB, and proportions by stage for blacks exceeded those for whites for Stage IIIB and Stage IV. The predicted proportions of white and black cases diagnosed at Stage IIIA were statistically identical. Significant changes in APCs were present among whites in Stage IA (at 2004), Stage IB (at 2006 and 2009), and Stage IV (at 2004). No statistically significant changes in APCs were detected among blacks.

Conclusion: Our methods to reclassify NSCLC cases according to AJCC6 appear reasonable to support analyses that require cancer stage and race of all cohort patients diagnosed between 2000 and 2011. Some year-to-year differences are present, but they appear at most 4.1 pp between 2003 and 2004. Following the stage reclassification, our results suggest that whites were more likely to be diagnosed at a favorable stage (IA, IB, IIA, and IIB) compared with blacks, while blacks were more likely to be diagnosed at a less favorable stage (IIIB and IV) compared with whites.

Citation Format: Thomas B. Richards, Serban Negoita, Timothy S. McNeel, Dylan L. Holt, Marie Topor, S Jane Henley, Arica White, Jun Li, Chunyu Li. Adjusted American Joint Committee on Cancer 6th edition stage for analysis of trends in black-white disparities in non-small cell lung cancer, SEER Medicare, 2000-2011. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B44.

Abstract B63: Disparities in lung cancer incidence rates and trends by histologic type in the United States, 2004-2009

Objective: Surveillance of lung cancer by histology type is important for monitoring population trends that have implication for etiology and prevention, clinical diagnosis, prognosis and choice of targeted therapies. This study provides a comprehensive and recent description of disparities in histologic lung cancer incidence rates and trends for U.S. adults.

Methods: Histologic lung cancer incidence was analyzed from CDC's National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. Standardized rates and trends were calculated for men and women by age, race/ethnicity, and U.S. Census region. Rate ratios were examined for differences in rates between men and women, and annual percent change was calculated to quantify changes in incidence rates over time.

Results: Adenocarcinoma and squamous cell carcinoma were the two most common histologic subtypes. Adenocarcinoma rates continued to increase in men and women, and squamous cell rates increased in women only. All histologic subtype rates for white women exceeded rates for black women, and histologic rates for black men exceeded those for white men, except for small cell carcinoma where rates were higher among white men. Among both men and women, the rate for Hispanics was nearly half the rate for non-Hispanic (NH) blacks and NH whites. Men had higher incidence rates than women for race and ethnic groups, but the relative size of this difference by sex was higher for NH blacks, NH Asian/Pacific Islanders and Hispanics compared with NH whites. The relative difference in incidence rates between men and women was slightly lower for NH American Indian/Alaska Native (AI/AN) populations than for whites. Differences between men and women living in the West were less pronounced compared to those living in other Census regions.

Conclusion: The variations observed by race and ethnicity, continuing rise in incidence rates of lung adenocarcinoma, and rise of squamous cell cancer rates in women suggest more research is needed to comprehensively understand factors that may be contributing to observed differences in lung cancer histology. Identification of these factors acting in addition to, or in synergy with cigarette smoking, may provide public health agencies with guidance for targeted messages to groups at higher risk.

Citation Format: Keisha Houston, S. Jane Henley, Jun Li, Mary C. White, Thomas B. Richards. Disparities in lung cancer incidence rates and trends by histologic type in the United States, 2004-2009. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B63.

Comorbidities, smoking status, and life expectancy among individuals eligible for lung cancer screening

BACKGROUND

Lung cancer screening recommendations are based on results from the National Lung Screening Trial (NLST). The authors determined how the screening-eligible US population differs from NLST participants in terms of characteristics that affect their ability to benefit from screening.

METHODS

The authors identified respondents to the 2012 Health and Retirement Study (HRS), a national survey of individuals aged ≥50 years who are eligible for screening based on US Preventive Services Task Force and Centers for Medicare and Medicaid Services criteria. Comorbidities, life expectancy, smoking history, and other characteristics were compared between the screening-eligible population and NLST participants.

RESULTS

The authors estimated that in 2013, 8.4 million individuals (95% confidence interval, 7.9-8.9 million individuals) would have met the eligibility criteria for lung cancer screening established by the US Preventive Services Task Force. Compared with NLST participants, HRS screening-eligible respondents were older, more likely to be current smokers, and more likely to have been diagnosed with comorbidities. The 5-year survival rate was 87% in the HRS screening-eligible individuals versus 93% in the NLST participants (P<.001, based on a 2-sided test). Life expectancy was 18.7 years in the HRS screening-eligible individuals versus 21.2 years in the NLST participants.

CONCLUSIONS

The US population eligible for lung cancer screening is probably less likely to benefit from early detection than NLST participants because they face a high risk of death from competing causes. The results of the current study highlight the need for smoking cessation interventions targeting those patients eligible for screening and tools to help clinicians determine the potential benefits of screening in individual patients.

CDC Grand Rounds: the future of cancer screening

Cancer is the second leading cause of death in the United States, with 52% of deaths caused by cancers of the lung and bronchus, female breast, uterine cervix, colon and rectum, oral cavity and pharynx, prostate, and skin (melanoma). In the 1930s, uterine cancer, including cancer of the uterine cervix, was the leading cause of cancer deaths among women in the United States. With the advent of the Papanicolaou (Pap) test in the 1950s to detect cellular level changes in the cervix, cervical cancer death rates declined significantly. Since this first cancer screening test, others have been developed that detect the presence of cancer through imaging procedures (e.g., mammography, endoscopy, and computed tomography) and laboratory tests (e.g., fecal occult blood tests).

Abstract C55: Racial disparities in receipt of initial prostate cancer treatment, SEER Medicare, 2004-2009

Purpose: Prostate cancer death rates are higher in blacks than whites. Using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, we evaluated whether racial disparities exist in the receipt of initial prostate cancer treatment.

Methods: We analyzed data on prostate cancer cases diagnosed in 2004-2009 and linked with Medicare claims data from 2003-2010. We focused on cases with SEER race coded as white or black; and enrolled in both Medicare Parts A and B continuously during 12 months before diagnosis to 24 months after diagnosis, death, or December 2010, whichever was earliest. We defined prostate cancer recurrence risk categories using tumor stage, prostate specific antigen (PSA), and Gleason scores. We identified initial prostate cancer treatment using: radical prostatectomy, radiation therapy, or androgen deprivation therapy within 1 month before to 6 months after diagnosis; or evidence of active surveillance based on prostate biopsies or PSA tests from 1 to 18 months after diagnosis. We used multivariate logistic regression to determine adjusted odds ratios (OR) and 95% confidence intervals (CI). The outcome variable was receipt of initial treatment. Explanatory variables were: race; prostate cancer disease recurrence risk category; asymptomatic or symptomatic at time of first diagnosis; life expectancy from the man's age at diagnosis; comorbidity; census tract poverty; and census region.

Results: Our final study cohort included 70,254 white men and 8,653 black men with prostate cancer. After adjustment for multiple variables, men were less likely to receive initial treatment if: expected survival &lt; 5 years (OR, 0.36; 95% CI, 0.33–0.40; ref.= &gt; 10 years); black race (OR, 0.54; 95% CI, 0.50–0.57; ref. = white); or symptomatic at time of diagnosis (OR, 0.77, 95% CI, 0.74–0.81; ref.=asymptomatic). Men were more likely to receive initial treatment if: high recurrence risk (OR, 2.75; 95% CI, 2.55–2.96; ref.= low); resided in Northeast (OR, 1.30; 95% CI 1.24–1.38; ref.= West); comorbidity score &gt; 2 (OR, 1.24; 95% CI, 1.17–1.31; ref. = 0); or lived in a census tract with &lt;5% poverty (OR, 1.14; 95% CI, 1.07–1.22; ref.= &gt; 19%).

Conclusion: Low expected survival and black race were relatively important reasons that older men did not receive initial treatment for prostate cancer.

Citation Format: Thomas B. Richards, Serban Negoita, Timothy S. McNeel, Jun Li, Chunyu Li. Racial disparities in receipt of initial prostate cancer treatment, SEER Medicare, 2004-2009. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C55. doi:10.1158/1538-7755.DISP13-C55

Patterns in lung cancer incidence rates and trends by histologic type in the United States, 2004-2009

OBJECTIVE

The examination of lung cancer by histology type is important for monitoring population trends that have implications for etiology and prevention, screening and clinical diagnosis, prognosis and treatment. We provide a comprehensive description of recent histologic lung cancer incidence rates and trends in the USA using combined population-based registry data for the entire nation.

MATERIALS AND METHODS

Histologic lung cancer incidence data was analyzed from CDC's National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. Standardized rates and trends were calculated for men and women by age, race/ethnicity, and U.S. Census region. Rate ratios were examined for differences in rates between men and women, and annual percent change was calculated to quantify changes in incidence rates over time.

RESULTS

Trend analysis demonstrate that overall rates have decreased, but incidence has remained stable for women aged 50 or older. Adenocarcinoma and squamous cell carcinoma were the two most common histologic subtypes. Adenocarcinoma rates continued to increase in men and women, and squamous cell rates increased in women only. All histologic subtype rates for white women exceeded rates for black women. Histologic rates for black men exceeded those for white men, except for small cell carcinoma. The incidence rate for Hispanics was nearly half the rate for blacks and whites.

CONCLUSION

The continuing rise in incidence of lung adenocarcinoma, the rise of squamous cell cancer in women, and differences by age, race, ethnicity and region points to the need to better understand factors acting in addition to, or in synergy with, cigarette smoking that may be contributing to observed differences in lung cancer histology.

Effect of gynecologic oncologist availability on ovarian cancer mortality

AIM: To determine the association between the distribution of gynecologic oncologist (GO) and population-based ovarian cancer death rates.

METHODS: Data on ovarian cancer incidence and mortality in the United States was supplemented with United States census data, and analyzed in relation to practicing GOs. GO locations were geocoded to link association between county variables and GO availability. Logistic regression was used to measure areas of high and low ovarian cancer mortality, adjusting for contextual variables.

RESULTS: Practicing GOs were unevenly distributed in the United States, with the greatest numbers in metropolitan areas. Ovarian cancer incidence and death rates increased as distance to a practicing GO increased. A relatively small number (153) of counties within 24 miles of a GO had high ovarian cancer death rates compared to 577 counties located 50 or more miles away with high ovarian cancer death rates. Counties located 50 or more miles away from a GO practice had an almost 60% greater odds of high ovarian cancer mortality compared to those with closer practicing GOs (OR = 1.59, 95%CI: 1.18-2.15).

CONCLUSION: The distribution of GOs across the United States appears to be significantly associated with ovarian cancer mortality. Efforts that facilitate outreach of GOs to certain populations may increase geographic access.

Methods for improving the quality and completeness of mortality data for American Indians and Alaska Natives

OBJECTIVES

We describe methods used to mitigate the effect of race misclassification in mortality records and the data sets used to improve mortality estimates for American Indians and Alaska Natives (AI/ANs).

METHODS

We linked US National Death Index (NDI) records with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN deaths. Analyses excluded decedents of Hispanic origin and focused on Contract Health Service Delivery Area (CHSDA) counties. We compared death rates for AI/AN persons and Whites across 6 US regions.

RESULTS

IHS registration records merged to 176,137 NDI records. Misclassification of AI/AN race in mortality data ranged from 6.3% in the Southwest to 35.6% in the Southern Plains. From 1999 to 2009, the all-cause death rate in CHSDA counties for AI/AN persons varied by geographic region and was 46% greater than that for Whites. Analyses for CHSDA counties resulted in higher death rates for AI/AN persons than in all counties combined.

CONCLUSIONS

Improving race classification among AI/AN decedents strengthens AI/AN mortality data, and analyzing deaths by geographic region can aid in planning, implementation, and evaluation of efforts to reduce health disparities in this population.

Lung cancer screening with low-dose computed tomography for primary care providers

This review provides an update on lung cancer screening with low-dose computed tomography (LDCT) and its implications for primary care providers. One of the unique features of lung cancer screening is the potential complexity in patient management if an LDCT scan reveals a small pulmonary nodule. Additional tests, consultation with multiple specialists, and follow-up evaluations may be needed to evaluate whether lung cancer is present. Primary care providers should know the resources available in their communities for lung cancer screening with LDCT and smoking cessation, and the key points to be addressed in informed and shared decision-making discussions with patients.

Lung cancer incidence trends among men and women--United States, 2005-2009

Lung cancer is the leading cause of cancer death and the second most commonly diagnosed cancer (excluding skin cancer) among men and women in the United States. Although lung cancer can be caused by environmental exposures, most efforts to prevent lung cancer emphasize tobacco control because 80%-90% of lung cancers are attributed to cigarette smoking and secondhand smoke. One sentinel health consequence of tobacco use is lung cancer, and one way to measure the impact of tobacco control is by examining trends in lung cancer incidence rates, particularly among younger adults. Changes in lung cancer rates among younger adults likely reflect recent changes in risk exposure. To assess lung cancer incidence and trends among men and women by age group, CDC used data from the National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for the period 2005-2009, the most recent data available. During the study period, lung cancer incidence decreased among men in all age groups except <35 years and decreased among women aged 35-44 years and 54-64 years. Lung cancer incidence decreased more rapidly among men than among women and more rapidly among adults aged 35-44 years than among other age groups. To further reduce lung cancer incidence in the United States, proven population-based tobacco prevention and control strategies should receive sustained attention and support.

US Primary Care Physicians' Prostate Cancer Screening Practices: A Vignette-Based Analysis of Screening Men at High Risk

BACKGROUND

Limited information exists on primary care physicians' (PCPs) use of the prostate-specific antigen (PSA) test by patient risk category. We describe PCP responses to hypothetical patient scenario (PS) involving PSA testing among high-risk asymptomatic men.

METHODS

Data were from the 2007 to 2008 National Survey of Primary Care Physicians' Practices Regarding Prostate Cancer Screening. PS#1: healthy 55-year-old white male with no family history of prostate cancer; PS#2: healthy 45-year-old African American male with no family history of prostate cancer; and PS#3: healthy 50-year-old male with a family history of prostate cancer. Data were analyzed in SAS/SUDAAN.

RESULTS

Most PCPs indicated that they generally discuss the possible benefits/risks of PSA testing with the patient and then recommend the test (PS#1-PS#3 range, 53.4%-68.7%; P < .001); only about 1% reported discussing and then recommending against the test. For PS#3, compared to PS#1 and #2, PCPs were more likely to discuss and recommend the test or attempt to persuade the patient who initially declines the test. For PS#3, all clinicians generally would order/discuss the PSA test and not rely on the patient to ask.

CONCLUSION

Clinicians treat family history as an important reason to recommend, persuade, and initiate PSA testing.

Characteristics of US counties with no mammography capacity

Access to screening mammography may be limited by the availability of facilities and machines, and nationwide mammography capacity has been declining. We assessed nationwide capacity at state and county levels from 2003 to 2009, the most recent year for which complete data were available. Using mammography facility certification and inspection data from the Food and Drug Administration, we geocoded all mammography facilities in the United States and determined the total number of fully accredited mammography machines in each US County. We categorized mammography capacity as counties with zero capacity (i.e., 0 machines) or counties with capacity (i.e.,≥1 machines), and then compared those two categories by sociodemographic, health care, and geographic characteristics. We found that mammography capacity was not distributed equally across counties within states and that more than 27 % of counties had zero capacity. Although the number of mammography facilities and machines decreased slightly from 2003 to 2009, the percentage of counties with zero capacity changed little. In adjusted analyses, having zero mammography capacity was most strongly associated with low population density (OR = 11.0; 95 % CI 7.7-15.9), low primary care physician density (OR = 8.9; 95 % CI 6.8-11.7), and a low percentage of insured residents (OR = 3.3; 95 % CI 2.5-4.3) when compared with counties having at least one mammography machine. Mammography capacity has been and remains a concern for a portion of the US population--a population that is mostly but not entirely rural.

Prostate cancer screening practices of African-American and non-African-American US primary care physicians: a cross-sectional survey

Purpose:

We explored whether African-American (AA) primary care physicians (PCPs) have different prostate cancer screening practices compared to non-AA PCPs, after adjustment for potential confounding factors such as the proportion of AA patients in PCP practices.

Methods:

We used SAS/SUDAAN to compare weighted responses from AA PCPs (n = 604) with those from non-AA PCPs (n = 647) in the 2007–2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening. We used multivariate logistic regression to calculate the weighted odds ratios (OR) and 95% confidence intervals (CI).

Results:

We found that AA PCPs had higher odds of working in practices with above-the-median (≥ 21%) proportions of AA male patients (OR, 9.02; 95% CI: 5.85–13.91). A higher proportion of AA PCPs (53.5%; 95% CI: 49.5–57.4) reported an above-the-median proportion (≥ 91%) of PSA testing during health maintenance exams as compared to non-AA PCPs (39.4%; 95% CI: 35.5–43.4; P < 0.0002). After adjusting for the proportion of AA patients and other factors, we found that AA PCPs had higher odds of using PSA tests to screen men (OR, 1.74; 95% CI: 1.11–2.73).

Conclusion:

This study quantifies the magnitude of the differences reported in previous focus group studies. Our results may be helpful in hypothesis generation and in planning future research studies.

Use of lung cancer screening tests in the United States: results from the 2010 National Health Interview Survey

BACKGROUND

Before evidence of efficacy, lung cancer screening was being ordered by many physicians. The National Lung Screening Trial (NLST), which showed a 20% reduction in lung cancer mortality among those randomized to receive low-dose computed tomography (LDCT), will likely lead to increased screening use.

METHODS

We estimated the prevalence of chest X-ray and CT use in the United States using data from the 2010 National Health Interview Survey (NHIS). Subjects included 15,537 NHIS respondents aged ≥40 years without prior diagnosis of lung cancer. Estimates of the size of the U. S. population by age and smoking status were calculated. Multivariate logistic regression examined predictors of test use adjusting for potential confounders.

RESULTS

Twenty-three percent of adults reported chest X-ray in the previous year and 2.5% reported chest X-ray specifically to check for lung cancer; corresponding numbers for chest CT were 7.5% and 1.3%. Older age, black race, male gender, smoking, respiratory disease, personal history of cancer, and having health insurance were associated with test use. Approximately, 8.7 million adults in the United States would be eligible for LDCT screening according to NLST eligibility criteria.

CONCLUSIONS AND IMPACT

Monitoring of trends in the use of lung screening tests will be vital to assess the impact of NLST and possible changes in lung cancer screening recommendations and insurance coverage in the future. Education of patients by their physicians, and of the general public, may help ensure that screening is used appropriately, in those most likely to benefit.

Lung cancer screening practices of primary care physicians: results from a national survey

PURPOSE

Although current practice guidelines do not recommend screening asymptomatic patients for lung cancer, physicians may still order lung cancer screening tests. No recent national survey of health care professionals has focused on lung cancer screening. In this study, we examined the lung cancer screening practices of US primary care physicians and characteristics of those who order lung cancer screening tests.

METHODS

We conducted a nationally representative survey of practicing primary care physicians in 2006-2007. Mailed questionnaires assessed the physicians' knowledge of lung cancer screening guidelines, beliefs about the effectiveness of screening tests, and ordering of screening chest radiograph, low-dose spiral computed tomography, or sputum cytology in the past 12 months. Clinical vignettes were used to assess the physicians' intentions to screen asymptomatic 50-year-old patients with varying smoking histories for lung cancer.

RESULTS

A total of 962 family physicians, general practitioners, and general internists completed questionnaires (cooperation rate = 76.8%). Overall, 38% had ordered no lung cancer screening tests; 55% had ordered chest radiograph, 22% low-dose spiral computed tomography, and less than 5% sputum cytology. In multivariate modeling, physicians were more likely to have ordered lung cancer screening tests if they believed that expert groups recommend lung cancer screening or that screening tests are effective; if they would recommend screening for asymptomatic patients, including patients without substantial smoking exposure; and if their patients had asked them about screening.

CONCLUSIONS

Primary care physicians in the United States frequently order lung cancer screening tests for asymptomatic patients, even though expert groups do not recommend it. Primary care physicians and patients need more information about lung cancer screening's evidence base, guidelines, potential harms, and costs to avert inappropriate ordering.

Surveillance of demographic characteristics and health behaviors among adult cancer survivors--Behavioral Risk Factor Surveillance System, United States, 2009

PROBLEM/CONDITION

Approximately 12 million people are living with cancer in the United States. Limited information is available on national and state assessments of health behaviors among cancer survivors. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), this report provides a descriptive state-level assessment of demographic characteristics and health behaviors among cancer survivors aged ≥18 years.

REPORTING PERIOD COVERED

2009

DESCRIPTION OF SYSTEM

BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. population aged ≥18 years. BRFSS collects information on health risk behaviors and use of preventive health services related to leading causes of death and morbidity. In 2009, BRFSS added questions about previous cancer diagnoses to the core module. The 2009 BRFSS also included an optional cancer survivorship module that assessed cancer treatment history and health insurance coverage for cancer survivors. In 2009, all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands administered the core cancer survivorship questions, and 10 states administered the optional supplemental cancer survivorship module. Five states added questions on mammography and Papanicolaou (Pap) test use, eight states included questions on colorectal screening, and five states included questions on prostate cancer screening.

RESULTS

An estimated 7.2% of the U.S. general population aged ≥18 years reported having received a previous cancer diagnosis (excluding nonmelanoma skin cancer). A total of 78.8% of cancer survivors were aged ≥50 years, and 39.2% had received a diagnosis of cancer >10 years previously. A total of 57.8% reported receiving an influenza vaccination during the previous year, and 48.3% reported ever receiving a pneumococcal vaccination. At the time of the interview, 6.8% of cancer survivors had no health insurance, and 12% had been denied health insurance, life insurance, or both because of their cancer diagnosis. The prevalence of cardiovascular disease was higher among male cancer survivors (23.4%) than female cancer survivors (14.3%), as was the prevalence of diabetes (19.6% and 14.7%, respectively). Overall, approximately 15.1% of cancer survivors were current cigarette smokers, 27.5% were obese, and 31.5% had not engaged in any leisure-time physical activity during the past 30 days. Demographic characteristics and health behaviors among cancer survivors varied substantially by state.

INTERPRETATION

Health behaviors and preventive health care practices among cancer survivors vary by state and demographic characteristics. A large proportion of cancer survivors have comorbid conditions, currently smoke, do not participate in any leisure-time physical activity, and are obese. In addition, many are not receiving recommended preventive care, including cancer screening and influenza and pneumococcal vaccinations.

PUBLIC HEALTH ACTION

Health-care providers and patients should be aware of the importance of preventive care, smoking cessation, regular physical activity, and maintaining a healthy weight for cancer survivors. The findings in this report can help public health practitioners, researchers, and comprehensive cancer control programs evaluate the effectiveness of program activities for cancer survivors, assess the needs of cancer survivors at the state level, and allocate appropriate resources to address those needs.

Association between cutaneous melanoma incidence rates among white US residents and county-level estimates of solar ultraviolet exposure

BACKGROUND

Recent US studies have raised questions as to whether geographic differences in cutaneous melanoma incidence rates are associated with differences in solar ultraviolet (UV) exposure.

OBJECTIVES

We sought to assess the association of solar UV exposure with melanoma incidence rates among US non-Hispanic whites.

METHODS

We assessed the association between county-level estimates of average annual solar UV exposure for 1961 to 1990 and county-level melanoma incidence rates during 2004 to 2006. We used Poisson multilevel mixed models to calculate incidence density ratios by cancer stage at diagnosis while controlling for individuals' age and sex and for county-level estimates of solar UV exposure, socioeconomic status, and physician density.

RESULTS

Age-adjusted rates of early- and late-stage melanoma were both significantly higher in high solar UV counties than in low solar UV counties. Rates of late-stage melanoma incidence were generally higher among men, but younger women had a higher rate of early-stage melanoma than their male counterparts. Adjusted rates of early-stage melanoma were significantly higher in high solar UV exposure counties among men aged 35 years or older and women aged 65 years or older.

LIMITATIONS

The relationship between individual-level UV exposure and risk for melanoma was not evaluated.

CONCLUSIONS

County-level solar UV exposure was associated with the incidence of early-stage melanoma among older US adults but not among younger US adults. Additional studies are needed to determine whether exposure to artificial sources of UV exposure or other factors might be mitigating the relationship between solar UV exposure and risk for melanoma.

Discussions about prostate cancer screening between U.S. primary care physicians and their patients

OBJECTIVE

This study examined the likelihood that U.S. primary care physicians (PCPs) discuss and recommend prostate cancer screening with their patients and physician-related and practice-related factors associated with this behavior.

METHODS

We analyzed data from the 2007-2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening (N = 1,256), the most recent and comprehensive survey specifically designed to address issues concerning prostate cancer screening and representing nearly 95,000 PCPs. We evaluated the relationship between PCP behavior regarding prostate cancer screening discussions and covariates, including PCP demographic and practice-related factors. Weighted percentages and Chi-square tests were used to compare use of screening discussions by PCP characteristics. Adjusted odds of discussing screening and recommending the PSA test were determined from logistic regression.

RESULTS

Eighty percent of PCPs reported that they routinely discuss prostate cancer screening with all of their male patients, and 64.1% of PCPs who discussed screening with any patients reported that they attempted to talk their patients into getting the PSA test. In multivariate analyses, encouraging PSA testing was more likely among non-Hispanic black PCPs (OR = 2.80, 95% CI [1.88, 4.16]), PCPs serving 100 or more patients per week (OR = 2.16, 95% CI [1.38, 3.37]), and PCPs spending longer hours per week in direct patient care (31-40 hours: OR = 1.90, 95% CI [1.13, 3.20]; 41 or more hours: OR = 2.09, 95% CI [1.12, 3.88]), compared to their referents. PCPs in multi-specialty group practice were more likely to remain neutral or discourage PSA testing compared to PCPs in solo practice.

CONCLUSIONS

Both individual and practice-related factors of PCPs were associated with the use of prostate cancer screening discussions by U.S. PCPs. Results from this study may prove valuable to researchers and clinicians and help guide the development and implementation of future prostate cancer screening interventions in the U.S.

Gynecologic oncologists and ovarian cancer treatment: avenues for improved survival

Ovarian cancer is the deadliest gynecologic malignancy in the United States. Evidence-based interventions for the prevention and early detection of ovarian cancer do not currently exist. However, several treatment guidelines, including the receipt of treatment from a gynecologic oncologist, have been shown to result in improved survival from ovarian cancer.