Journal Article

An Ecologic Study of Prostate-specific Antigen Screening and Prostate Cancer Mortality in Nine Geographic Areas of the United States

Pamela A. Shaw, Ruth Etzioni, Steven B. Zeliadt, Angela Mariotto, Kent Karnofski, David F. Penson, Noel S. Weiss and Eric J. Feuer

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 160, issue 11, pages 1059-1069
Published in print December 2004 | ISSN: 0002-9262
Published online December 2004 | e-ISSN: 1476-6256 | DOI:
An Ecologic Study of Prostate-specific Antigen Screening and Prostate Cancer Mortality in Nine Geographic Areas of the United States

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Ecologic studies of cancer screening examine cancer mortality rates in relation to use of population screening. These studies can be confounded by treatment patterns or influenced by choice of outcome and time horizon. Interpretation can be complicated by uncertainty about when mortality differences might be expected. The authors examined these issues in an ecologic analysis of prostate-specific antigen (PSA) screening and prostate cancer mortality across nine cancer registries in the United States. Results suggested a weak trend for areas with greater PSA screening rates to have greater declines in prostate cancer mortality; however, the magnitude of this trend varied considerably with the time horizon and outcome measure. A computer model was used to determine whether divergence of mortality declines would be expected under an assumption of a clinically significant survival benefit due to screening. Given a mean lead time of 5 years, the model projected that differences in mortality between high- and low-use areas should be apparent by 1999 in the absence of other factors affecting mortality. The authors concluded that modest differences in PSA screening rates across areas, together with additional sources of variation, could have produced a negative ecologic result. Ecologic analyses of the effectiveness of PSA testing should be interpreted with caution.

Keywords: computer simulation; confounding factors (epidemiology); mass screening; mortality; prostate-specific antigen; prostatic neoplasms; Abbreviations: APC, annual percentage change; HT, hormone ablation therapy; PSA, prostate-specific antigen; SEER, Surveillance, Epidemiology, and End Results.

Journal Article.  6263 words.  Illustrated.

Subjects: Public Health and Epidemiology

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