Prostate cancer incidence among American Indian and Alaska Native men, US, 1999-2004.
BACKGROUND
American Indian and Alaska Native (AI/AN) men experience lower incidence of prostate cancer than other race/ethnic populations in the US, but racial misclassification of AI/AN men threatens the validity of these estimates. To the authors' knowledge, little is known concerning prostate-specific antigen (PSA) testing in AI/AN men.


METHODS
The authors linked cancer registry data with Indian Health Service enrollment records to improve race classification. Analyses comparing cancer incidence rates and stage at diagnosis for AI/AN and non-Hispanic white (NHW) men for 6 geographic regions focused on counties known to have less race misclassification. The authors also used Behavioral Risk Factors Surveillance System data to characterize PSA testing in AI/AN men.


RESULTS
Prostate cancer incidence rates were generally lower in AI/AN than in NHW men for all regions combined (rate ratio of 0.68). However, regional variation was noted among AI/AN men, with incidence rates (per 100,000 population) ranging from 65.7 in the Southwest to 174.5 on the Northern Plains. The rate of distant stage disease was somewhat higher among AI/AN (7.8) than NHW (6.2) men. Nationally, AI/AN men were less likely than NHW men to have undergone recent PSA testing (48.4% vs 58.0%), with prominent regional variation in screening rates noted.


CONCLUSIONS
Prostate cancer incidence rates and the proportion of men with recent PSA testing were lower for AI/AN men than for NHW men. However, incident rates and rate of distant stage varied by region more for AI/AN than for NHW. Further research is needed among AI/AN men to evaluate strategies for better understanding the causes of the regional variation in prostate cancer incidence.
Henderson
Jeffrey A
JA
Black Hills Center for American Indian Health, Rapid City, South Dakota 57701, USA. jhenderson@bhcaih.org
Espey
David K
DK
Jim
Melissa A
MA
German
Robert R
RR
Shaw
Kate M
KM
Hoffman
Richard M
RM
D000230:Adenocarcinoma / Q000208:ethnology*; D000328:Adult; D000368:Aged; D000413:Alaska / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000208:ethnology*; D044469:Racial Groups / Q000706:statistics & numerical data; D012042:Registries; D014481:United States / Q000453:epidemiology
D017430:Prostate-Specific Antigen