Copyright © 2004 by the Johns Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
An Ecologic Study of Prostate-specific Antigen Screening and Prostate Cancer Mortality in Nine Geographic Areas of the United States
1 Fred Hutchinson Cancer Research Center, Seattle, WA.
2 Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle, WA.
3 Statistical Research and Applications Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD.
4 Keck School of Medicine, University of Southern California/Norris Cancer Center, Los Angeles, CA.
5 Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA.
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.
computer simulation; confounding factors (epidemiology); mass screening; mortality; prostate-specific antigen; prostatic neoplasms
Abbreviations: Abbreviations: APC, annual percentage change; HT, hormone ablation therapy; PSA, prostate-specific antigen; SEER, Surveillance, Epidemiology, and End Results.
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