|The following article features coverage from the 2021 ASCO Quality Care Symposium. Click here to read more of Cancer Therapy Advisor’s conference coverage.|
A prostate-specific antigen (PSA) screening recommendation made in 2012 may have had detrimental effects on cancer-specific survival, according to a study presented at the 2021 American Society of Clinical Oncology (ASCO) Quality Care Symposium.
In May 2012, the United States Preventative Services Task Force (USPSTF) recommended against PSA-based screening for prostate cancer.
With the current study, researchers set out to determine how this recommendation may have affected survival disparities according to insurance status, socioeconomic quintile, marital status, and urban vs rural housing.
The researchers analyzed data from the Surveillance, Epidemiology, and End Results (SEER) 18 database for 2010-2012 (before the USPSTF recommendation was made) and 2014-2016 (after the recommendation).
The study’s primary endpoint was prostate cancer-specific survival (PCSS).
Decreased Survival for Insured Patients
The USPSTF recommendation appeared to eliminate the PCSS disparity between insured and uninsured patients, but this was the result of a decrease in PCSS for insured patients.
With insured patients as the reference, the adjusted hazard ratio (aHR) for PCSS was 1.250 (P =.023) for uninsured patients in the pre-recommendation era and 0.943 in the post-recommendation era (P =.768).
The 3-year PCSS decreased significantly for insured patients from the pre- to the post-recommendation era (P <.001) but remained the same over time for the uninsured patients (P =.2729).
“The disappearance of PCSS disparity between insured and uninsured patients after the 2012 screening recommendation occurred due to a decrease in PCSS among insured patients, combined with no changed in PCSS among uninsured patients,” said Isaac E. Kim, Jr, a PhD student at Brown University in Providence, Rhode Island, who presented these findings at the meeting.
“This finding suggests that, in the pre-era, insured men were more likely to be screened for prostate cancer than uninsured men, likely due to more consistent urologic care as well as insurance coverage of PSA screening,” Mr Kim added. “And so, in recommending against PSA-based screening, the USPSTF may have inadvertently discouraged more insured patients from being screened for prostate cancer.”
Decreased Survival in All Other Groups
The PCSS disparity between married and unmarried patients widened from the pre- to the post-recommendation era. With married patients as the reference, the aHR for PCSS was 1.123 (P =.009) for unmarried patients in the pre-recommendation era and 1.395 in the post-recommendation era (P <.001).
Mr Kim said the widening disparity was due to a disproportionately larger decrease in survival among unmarried patients compared with married patients. Still, both married and unmarried patients saw significant decreases in 3-year PCSS from the pre- to post-recommendation era (P <.001 for both).
PCSS disparities between the highest and lowest socioeconomic quintiles remained consistent over time, but both groups saw a significant decrease in 3-year PCSS from the pre- to post-recommendation era (P <.001 for both).
There were no PCSS disparities based on housing status before or after the recommendation was made. However, both rural and urban groups had a significant decrease in 3-year PCSS from the pre- to post-recommendation era (P <.001 for both).
Based on these results, Mr Kim concluded that “the USPSTF’s 2012 PSA screening recommendation may have had unintended, detrimental effects on socioeconomic disparities.”
He added that alternative approaches to prostate cancer screening may be necessary to improve survival across all socioeconomic backgrounds.
Kim IE Jr, Kim DD, Kim S, et al. Abrogation of survival disparity between insured and uninsured individuals after the USPSTF’s 2012 prostate-specific antigen-based prostate cancer screening recommendation. J Clin Oncol. 2021;39:(suppl 28; abstr 77). doi:10.1200/JCO.2020.39.28_suppl.077