title: Association between race and follow-up diagnostic care after a positive prostate cancer screening test in the prostate, lung, colorectal, and ovarian cancer screening trial.
abstract: BACKGROUND
  Follow-through of a positive screening test is necessary to reap the potential benefits of cancer screening. Racial variation in follow-through diagnostic care may underlie a proportion of the known disparity in prostate cancer mortality. The authors used data from the screening arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial to determine whether race is associated with the use of follow-up diagnostic testing after a positive initial screening evaluation.
  
  
  METHODS
  Men who had a prostate-specific antigen (PSA) level >4 ng/mL at any time during the study were included. The proportion of men who underwent follow-up evaluation with a repeat PSA, a prostate biopsy, or either test within 9 months was determined, and the authors tested for differences in follow-through according to race using mixed-effects multivariate models with a random effect for accrual site to account for clustering. Models were stratified according to age (<65 years and ≥65 years).
  
  
  RESULTS
  Among 6294 men who had a PSA elevation during the study period, 70% underwent a repeat PSA or prostate biopsy within 9 months. Non-Hispanic black men aged <65 years had 45% lower odds of undergoing a repeat PSA test or prostate biopsy compared with non-Hispanic white men (odds ratio, 0.55; 95% confidence interval, 0.37-0.82), whereas there was no racial difference in follow-through among older men.
  
  
  CONCLUSIONS
  The current results suggest that limitations in access to care among non-Hispanic black men under the age of Medicare eligibility may underlie the paradoxically low use of follow-through diagnostic care among non-Hispanic black men in the United States.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee 37232, USA. dan.barocasVC vanderbilt.edu
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
authors.forename: Robert
authors.initials: R
authors.lastname: Grubb
authors.forename: Amanda
authors.initials: A
authors.lastname: Black
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.forename: Jay H
authors.initials: JH
authors.lastname: Fowke
authors.forename: Gerald
authors.initials: G
authors.lastname: Andriole
authors.forename: E David
authors.initials: ED
authors.lastname: Crawford
mesh_terms: D001741:Black or African American; D000368:Aged; D001706:Biopsy; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012959:Socioeconomic Factors; D014481:United States; D044465:White People
chemical_list: D017430:Prostate-Specific Antigen