How family history and race influence prostate cancer screening

Abstract

Background: Most major U.S. medical organizations recommend that screening for prostate cancer using the prostate-specific antigen (PSA) test should be based on individual patient preferences. Men with risk factors for prostate cancer diagnosis and mortality may have different preferences for screening than men without any risk factors. Methods: We used nationally-representative survey data from the 2005 and 2010 National Health Interview Survey to assess PSA-screening patterns by age, family history of prostate cancer and race among men in the United States over 40 years old using bivariate and multivariable logistic regression. Results: Men with any family history of prostate cancer were more likely to be screened using the PSA test in the last two years at any age (OR=2.2, 95% CI 1.8-2.6), and men with a father and brother diagnosed were more likely to be screened than men with only a father diagnosed, after adjustment (p=0.019). Younger (40-54 year old) African-American or black men had a higher odds of being screened than White, non-Hispanic men of the same age, after adjustment (OR=1.5, 95% CI=1.2-1.9), but this same adjusted comparison within other age groups indicated no significant difference in screening rates by race (age 55-69 years old: OR=1.0, 95% CI=0.8-1.3; age 70 years or more: OR=-0.9, 95% CI=0.7-1.3). Conclusion: There is considerable heterogeneity in PSA-screening practices. A family history of prostate cancer, and to a limited degree black or African-American race, both contribute to increased odds of undergoing screening. Understanding how to discuss risk factors with men to ensure individual patient preferences are appropriately integrated into screening decisions should be a priority for providers.