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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.

Abstract

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.

RESULTS/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.

IMPLICATIONS

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.

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  • Authors+Show Affiliations

    ,

    Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA. bh43a@nih.gov

    , , , , , , ,

    Source

    Journal of the National Cancer Institute 91:12 1999 Jun 16 pg 1017-24

    MeSH

    African Americans
    Age Distribution
    Aged
    Aged, 80 and over
    European Continental Ancestry Group
    Humans
    Incidence
    Male
    Mass Screening
    Middle Aged
    Mortality
    Neoplasm Staging
    Population Surveillance
    Prostate-Specific Antigen
    Prostatic Neoplasms
    SEER Program
    Survival Rate
    United States

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    10379964

    Citation

    Hankey, B F., et al. "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." Journal of the National Cancer Institute, vol. 91, no. 12, 1999, pp. 1017-24.
    Hankey BF, Feuer EJ, Clegg LX, et al. 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. J Natl Cancer Inst. 1999;91(12):1017-24.
    Hankey, B. F., Feuer, E. J., Clegg, L. X., Hayes, R. B., Legler, J. M., Prorok, P. C., ... Kaplan, R. S. (1999). 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. Journal of the National Cancer Institute, 91(12), pp. 1017-24.
    Hankey BF, et al. 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. J Natl Cancer Inst. 1999 Jun 16;91(12):1017-24. PubMed PMID: 10379964.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - 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. AU - Hankey,B F, AU - Feuer,E J, AU - Clegg,L X, AU - Hayes,R B, AU - Legler,J M, AU - Prorok,P C, AU - Ries,L A, AU - Merrill,R M, AU - Kaplan,R S, PY - 1999/6/24/pubmed PY - 1999/6/24/medline PY - 1999/6/24/entrez SP - 1017 EP - 24 JF - Journal of the National Cancer Institute JO - J. Natl. Cancer Inst. VL - 91 IS - 12 N2 - 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. RESULTS/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. IMPLICATIONS: 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. SN - 0027-8874 UR - https://www.unboundmedicine.com/medline/citation/10379964/full_citation L2 - https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/91.12.1017 DB - PRIME DP - Unbound Medicine ER -