title: Do racial disparities exist in the use of prostate cancer screening and detection tools in veterans?
abstract: OBJECTIVE
  To determine whether racial disparities exist in the use of prostate cancer screening and detection tools in veterans.
  
  
  METHODS
  Administrative data were obtained from the Corporate Data Warehouse on a national cohort of 275,831 veterans (21% African American [AA]) between the ages of 40 and 70 years who were free of heart disease, did not have an elevated prostate specific antigen (PSA) level (>4 ng/ml), did not have other clinical signs of prostate cancer, had not been diagnosed with prostate cancer, and had not received treatment for prostate cancer between January 10, 1998 and September 30, 2000. Subjects were followed up until September 30, 2007. Regular users were defined as those with at least 1 annual visit to the Veterans Healthcare Administration (VHA) between October 1, 1998 and September 30, 2000. We sought to determine if race was significantly associated with PSA testing, the time to elevated PSA detection, the time to prostate biopsy, and the time to diagnosis of prostate cancer. Chi-square tests, logistic regression, and Cox proportional hazard models were used to test for associations between race and prostate cancer variables.
  
  
  RESULTS
  Eighty-four percent of the veterans between the ages 40 and 70 years undergo PSA testing. AA veterans are as likely as white veterans to undergo PSA testing. Screened AA veterans are more likely to have a PSA>4 ng/ml, undergo prostate biopsy, and be diagnosed with prostate cancer than screened white veterans. The time intervals between undergoing a prostate biopsy and being diagnosed with prostate cancer were statistically significantly shorter (although unlikely of clinical significance) for AA veterans with a PSA level>4 ng/ml than that for white veterans with a PSA level>4 ng/ml. When routine care in regular VHA users was compared with that of participants in major screening trials such as Prostate, Lung, Ovarian and Colon Cancer Trial and European Study of Screening for Prostate Cancer, prostate biopsy rates were lower (30% vs. 40%-86%), prostate cancer detection rates/person biopsied were higher (49% vs. 31%-45%), and incidence of prostate cancer was 1.1% vs. 4.9% to 8.3%.
  
  
  CONCLUSIONS
  Among regular users of the VHA for healthcare, no disparities toward AA veterans exist in the use of prostate cancer screening and detection tools. Any differences in prostate cancer treatment outcomes are not likely because of inequalities in the use of prostate cancer screening or detection tools.
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO; Clinical Research and Epidemiology Workgroup, John Cochran VAMC, St. Louis, MO. Electronic address: mlhudson@ochsner.org.
authors.forename: M'Liss A
authors.initials: MA
authors.lastname: Hudson
authors.affiliation: Clinical Research and Epidemiology Workgroup, John Cochran VAMC, St. Louis, MO.
authors.forename: Suhong
authors.initials: S
authors.lastname: Luo
authors.affiliation: Clinical Research and Epidemiology Workgroup, John Cochran VAMC, St. Louis, MO.
authors.forename: Timothy
authors.initials: T
authors.lastname: Chrusciel
authors.affiliation: Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO; Clinical Research and Epidemiology Workgroup, John Cochran VAMC, St. Louis, MO.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Grubb
authors.affiliation: Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Carson
authors.affiliation: Clinical Research and Epidemiology Workgroup, John Cochran VAMC, St. Louis, MO; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Scherrer
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D044465:White People
chemical_list: D017430:Prostate-Specific Antigen
keywords: Access to care; African American; Cancer detection; Cancer screening; Prostate cancer; Prostate-specific antigen; Racial disparities