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Race and overall survival in men diagnosed with prostate cancer in the Department of Defense Military Health System, 1990–2010

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Abstract

Background

In the U.S. general population, black men experience poorer survival after prostate cancer (CaP) diagnosis compared to white men, and findings may be impacted by unequal access to healthcare. The objective of the study is to investigate racial differences in overall survival (OS) among Department of Defense beneficiaries diagnosed with CaP.

Methods

A retrospective cohort study was conducted utilizing the Automated Central Tumor Registry within the Military Healthcare System, a system designed to provide equal access. Men diagnosed with primary prostate adenocarcinomas between 1990 and 2010 [n = 18,484; 24% Non-Hispanic black (NHB), 76% Non-Hispanic white (NHW)] were followed through 2013 for vital status. Unadjusted Kaplan–Meier estimation curves and multivariable Cox proportional hazards (PH) regression models were used to examine racial differences in OS.

Results

Age-specific Kaplan–Meier analyses showed equivalent OS for NHW and NHB men in all age groups, except for 75+, where NHB had poorer OS (p = 0.0048). Multivariable Cox PH models revealed no significant differences in OS for race (HR 1.02; 95% CI 0.95–1.08), except in men aged ≥ 75 years, where NHB men had poorer OS (HR 1.27; 95% CI 1.08–1.49).

Conclusions

Findings suggest that in a healthcare system designed for equal access, disparities in OS among men diagnosed with CaP may not exist.

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References

  1. Siegel RL, Miller KD, Jemal A (2016) Cancer statistics. CA Cancer J Clin 66(1):7–30

    Article  Google Scholar 

  2. DeSantis C, Naishadham D, Jemal A (2013) Cancer statistics for African Americans. CA Cancer J Clin 63(3):151–166

    Google Scholar 

  3. Kelly SP et al (2017) Trends in the incidence of fatal prostate cancer in the United States by race. Eur Urol 71(2):195–201

    Article  PubMed  Google Scholar 

  4. Robbins HA et al (2015) Age at cancer diagnosis for blacks compared with whites in the United States. J Natl Cancer Inst. 107(3)

  5. Freedland SJ, Isaacs WB (2005) Explaining racial differences in prostate cancer in the United States: sociology or biology? Prostate 62(3):243–252

    Article  PubMed  Google Scholar 

  6. Zeigler-Johnson CM et al (2008) Genetic susceptibility to prostate cancer in men of African descent: implications for global disparities in incidence and outcomes. Can J Urol 15(1):3872–3882

    PubMed  PubMed Central  Google Scholar 

  7. Taksler GB, Keating NL, Cutler DM (2012) Explaining racial differences in prostate cancer mortality. Cancer 118(17):4280–4289

    Article  PubMed  Google Scholar 

  8. Barocas DA et al (2013) Association between race and follow-up diagnostic care after a positive prostate cancer screening test in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer 119(12):2223–2229

    Article  PubMed  Google Scholar 

  9. Berglund A et al (2012) Differences according to socioeconomic status in the management and mortality in men with high risk prostate cancer. Eur J Cancer 48(1):75–84

    Article  PubMed  Google Scholar 

  10. Friedman DB et al (2009) African American men’s understanding and perceptions about prostate cancer: why multiple dimensions of health literacy are important in cancer communication. J Commun Health 34(5):449–460

    Article  Google Scholar 

  11. Mahal BA et al (2014) Getting back to equal: The influence of insurance status on racial disparities in the treatment of African American men with high-risk prostate cancer. Urol Oncol 32(8):1285–1291

    Article  PubMed  Google Scholar 

  12. Cullen J et al (2011) Racial/Ethnic patterns in prostate cancer outcomes in an active surveillance cohort. Prostate Cancer 2011:234519

    Article  PubMed  PubMed Central  Google Scholar 

  13. Graham-Steed T et al (2013) ‘Race’ and prostate cancer mortality in equal-access healthcare systems. Am J Med 126(12):1084–1088

    Article  PubMed  PubMed Central  Google Scholar 

  14. Freeman VL et al (2003) Determinants of mortality following a diagnosis of prostate cancer in Veterans Affairs and private sector health care systems. Am J Public Health 93(10):1706–1712

    Article  PubMed  PubMed Central  Google Scholar 

  15. Schreiber D et al (2014) Impact of race in a predominantly African-American population of patients with low/intermediate risk prostate cancer undergoing radical prostatectomy within an equal access care institution. Int Urol Nephrol 46(10):1941–1946

    Article  PubMed  Google Scholar 

  16. Optenberg SA et al (1995) Race, treatment, and long-term survival from prostate cancer in an equal-access medical care delivery system. JAMA 274(20):1599–1605

    Article  CAS  PubMed  Google Scholar 

  17. Brawn PN et al (1993) Stage at presentation and survival of white and black patients with prostate carcinoma. Cancer 71(8):5

    Article  Google Scholar 

  18. Defense Health Agency (2018) https://www.health.mil.About-MHS. Accessed 1 Oct 2018]

  19. Enewold L et al (2012) Racial variation in tumor stage at diagnosis among Department of Defense beneficiaries. Cancer 118(5):1397–1403. https://doi.org/10.1002/cncr.26208

    Article  PubMed  Google Scholar 

  20. Lin J et al (2015) Survival among Black and White patients with renal cell carcinoma in an equal-access health care system. Cancer Causes Control 26(7):1019–1026. https://doi.org/10.1007/s10552-015-0594-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Schinkel JK et al., Overall and recurrence-free survival among black and white bladder cancer patients in an equal-access health system. Cancer Epidemiol, 2016. 42:154–158. https://doi.org/10.1016/j.canep.2016.04.012

    Article  Google Scholar 

  22. Zheng L et al (2012) Lung cancer survival among black and white patients in an equal access health system. Cancer Epidemiol Biomark Prev 21(10):1841–1847. https://doi.org/10.1158/1055-9965.EPI-12-0560

    Article  Google Scholar 

  23. Commission on Cancer, Facility Oncology Registry Data Standards (2015) American College of Surgeons

  24. Commission on Cancer, Cancer Program Standards 2012: Ensuring Patient-Centered Care, in Data Quality (2012) American College of Surgeons

  25. Fritz A et al. (2000) International classification of diseases for oncology. World Health Organization, Geneva

    Google Scholar 

  26. Humphrey PA (2012) Histological variants of prostatic carcinoma and their significance. Histopathology 60(1):59–74

    Article  PubMed  Google Scholar 

  27. American Joint Committee on Cancer (2002) AJCC cancer staging manual, 6th edn. Springer, New York

    Google Scholar 

  28. Daskivich TJ et al (2015) Racial parity in tumor burden, treatment choice and survival outcomes in men with prostate cancer in the VA healthcare system. Prostate Cancer Prostatic Dis 18(2):104–109

    Article  CAS  PubMed  Google Scholar 

  29. Bill-Axelson A et al (2011) Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 364(18):1708–1717

    Article  CAS  Google Scholar 

  30. Kibel AS et al (2012) Survival among men with clinically localized prostate cancer treated with radical prostatectomy or radiation therapy in the prostate specific antigen era. J Urol 187(4):1259–1265

    Article  PubMed  Google Scholar 

  31. Moses KA et al (2010) Impact of ethnicity on primary treatment choice and mortality in men with prostate cancer: data from CaPSURE. J Clin Oncol 28(6):1069–1074

    Article  PubMed  PubMed Central  Google Scholar 

  32. Moses KA et al (2016) Racial/ethnic differences in the relative risk of receipt of specific treatment among men with prostate cancer. Urol Oncol 34(9):415 e7–415 e12

    Article  Google Scholar 

  33. Arias E (2014) United States life tables, 2009, in national vital statistics reports. National Center for Health Statistics, Hyattsville, MD, p 63

  34. Powell IJ et al (2013) Genes associated with prostate cancer are differentially expressed in African American and European American men. Cancer Epidemiol Biomark Prev 22(5):891–897

    Article  CAS  Google Scholar 

  35. Wallace TA et al (2008) Tumor immunobiological differences in prostate cancer between African-American and European-American men. Cancer Res 68(3):927–936

    Article  CAS  PubMed  Google Scholar 

  36. Farrell J et al (2013) Genetic and molecular differences in prostate carcinogenesis between African American and Caucasian American men. Int J Mol Sci 14(8):15510–15531

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Rosen P et al (2012) Differences in frequency of ERG oncoprotein expression between index tumors of Caucasian and African American patients with prostate cancer. Urology 80(4):749–753

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

This project was supported by John P. Murtha Cancer Center, Walter Reed National Military Medical Center via the Uniformed Services University of the Health Sciences under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine. The authors thank the Joint Pathology Center (formerly Armed Forces Institute of Pathology) for providing the data. The authors would like to thank Ms. Elizabeth Butts for her input about the ACTUR and its compliance with the Commission on Cancer.

Disclaimer

The content of this publication is the sole responsibility of the authors and does not necessarily reflect the views or policies of the Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DoD), or the Departments of the Army, Navy, or Air Force.

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Authors and Affiliations

  1. Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    Melannie Alexander, Celia Byrne & Jennifer Rusiecki

  2. John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Melannie Alexander, Kangmin Zhu, Derek Brown & Stephanie Shao

  3. Department of Surgery, Center for Prostate Disease Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Jennifer Cullen

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  1. Melannie Alexander
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  2. Kangmin Zhu
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  3. Jennifer Cullen
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  5. Derek Brown
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Correspondence to Jennifer Rusiecki.

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Alexander, M., Zhu, K., Cullen, J. et al. Race and overall survival in men diagnosed with prostate cancer in the Department of Defense Military Health System, 1990–2010. Cancer Causes Control 30, 627–635 (2019). https://doi.org/10.1007/s10552-019-01163-5

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  • DOI: https://doi.org/10.1007/s10552-019-01163-5

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