Understanding prostate cancer disparities among at-risk minorities: The intersection of race and PSA testing

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Background:
 African-American men have a significantly higher burden of prostate cancer and lower rates of prostate specific antigen (PSA) testing than white men. The American Cancer Society recommends that men at average risk of prostate cancer be offered the PSA test at age 50, while men at high risk, including African-American men, should begin testing at 45 years of age. This study presents the national prevalence of PSA testing patterns by both patient race and age in order to assess whether African American men are being screened earlier.
 Methods:
 We analyzed the CDC’s 2001-05 National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS), a survey of private physicians offices and outpatient department(OPD)s to describe patterns of PSA testing among men 40 years and older. Response rates from this survey range from 62%-70% (NAMCS) and 73%-75% (NHAMCS OPD). The data on PSA tests includes visits made by patients with no prostate cancer or symptoms to the offices of general/family practice, internal medicine and urology physicians, and to the general medicine clinics of hospital OPDs. Patient variables include age, race/ethnicity, and method of payment and non-public use variables such as patient income and education. The unit of analysis is the physician-patient visit. A PSA screening visit is defined as the notation of a PSA test provided/ordered upon patient visit as a diagnostic/screening service. All data were weighted to reflect the probability of selection with adjustments for non-response to provide national estimates of PSA screening.
 Results:
 Of the 110 million estimated visits in physician offices for men 40 and older, approximately 10 million were PSA screening visits. Of the 11 million estimated visits in hospital outpatient department, approximately 375,000 visits had a PSA ordered or referred. Initial findings suggest that PSA screening was similar among African-American (9.9% NAMCS; 2.9% NHAMCS) and white men (9.2%; 3.4%). While PSA screening rates were generally lower among 40-49 years olds (5.5%; 1.9%) than for older age groups [(50-59: 10.4%; 3.7%)(60-69: 12.4%; 3.8%)(≥70: 8.8%; 4.4%)], there were no differences between white and African-American men. Higher PSA screening rates were noted among all men with private insurance (10.2%; 3.9%) and Medicare (9.0%; 3.7%) compared to patients who are self/uninsured (3.5%; 1.9%). PSA screening was also greater among preventive care visits (28.7%; 13.3%) compared to chronic (8.7%; 3.2%) or acute care (3.5%; 1.4%) patient visits. PSA screening was notably higher among visits where 30 or more minutes with the physician were spent (20.1% NAMCS only); (<15 minutes 5.7%; 15-30 minutes 7.3%).
 Conclusions:
 PSA screening visits were similar among African-American men and white men at younger ages despite ACS screening guidelines recommending onset of screening at age 45 for African-American men. More research is needed to determine how race and access to care predicts cancer screening behaviors. Results of this survey may guide cancer screening interventions and inform healthcare policy.