Cancer surveillance series: interpreting trends in prostate cancer--part I: Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates.
BACKGROUND
The prostate-specific antigen test was approved by the U.S. Food and Drug Administration in 1986 to monitor the disease status in patients with prostate cancer and, in 1994, to aid in prostate cancer detection. However, after 1986, the test was performed on many men who had not been previously diagnosed with prostate cancer, apparently resulting in the diagnosis of a substantial number of early tumors. Our purpose is to provide insight into the effect of screening on prostate cancer rates. Detailed data are presented for whites because the size of the population allows for calculating statistically reliable rates; however, similar overall trends are seen for African-Americans and other races.


METHODS
Prostate cancer incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program and mortality data from the National Center for Health Statistics were analyzed.


CONCLUSIONS
The following findings are consistent with a screening effect: 1) the recent decrease since 1991 in the incidence of distant stage disease, after not having been perturbed by screening; 2) the decline in the incidence of earlier stage disease beginning the following year (i.e., 1992); 3) the recent increases and decreases in prostate cancer incidence and mortality by age that appear to indicate a calendar period effect; and 4) trends in the incidence of distant stage disease by tumor grade and trends in the survival of patients with distant stage disease by calendar year that provide suggestive evidence of the tendency of screening to detect slower growing tumors.


CONCLUSIONS
The decline in the incidence of distant stage disease holds the promise that testing for prostate-specific antigen may lead to a sustained decline in prostate cancer mortality. However, population data are complex, and it is difficult to confidently attribute relatively small changes in mortality to any one cause.
Hankey
B F
BF
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA. bh43a@nih.gov
Feuer
E J
EJ
Clegg
L X
LX
Hayes
R B
RB
Legler
J M
JM
Prorok
P C
PC
Ries
L A
LA
Merrill
R M
RM
Kaplan
R S
RS
D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009367:Neoplasm Staging; D011159:Population Surveillance; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology / Q000401:mortality / Q000473:pathology; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
D017430:Prostate-Specific Antigen