199164 Prostate cancer severity among low-income, uninsured men

Tuesday, November 10, 2009: 12:30 PM

David C./ Miller, MD, MPH , VA Ctr for Clin Mgmt Research University of Michigan, Assistant Professor of Urology and Epidemiology Research Scientist, Ann Arbor, MI
Mark S. Litwin, MD, MPH , Urology and Health Services, David Geffen School of Medicine at UCLA, Los Angeles, CA
Jonathan Bergman, MD , Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
Sevan Stepanian, MD , Urology, UCLA, Los Angeles, CA
Sarah E. Connor, MPH, CHES , Department of Urology, Health Services Research Group, UCLA, Los Angeles, CA
Lorna Kwan, MPH , Division of Cancer Prevention Control and Research, Jonsson Comprehensive Cancer Center, School of Public Health, UCLA, Los Angeles, CA
William J. Aronson, MD , Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
The objective of cancer screening is to detect a cancer early and improve the chance of a cure. With prostate cancer, however, there is an ongoing controversy regarding whether or not it saves lives. Early detection has become linked with the notion of unnecessary and overtreatment. Despite this controversy, the proportion of men diagnosed with organ-confined, low-risk prostate cancer has increased significantly during the last 20 years leading to a decline in mortality. However, it is unclear whether this trend also applies to socioeconomically disadvantaged men.

This presentation describes the evaluation of prostate cancer severity among an ethnically diverse cohort of low-income, uninsured men enrolled in a state-funded public health program providing free prostate cancer treatment. A retrospective cohort study of 570 men was performed. Cancer severity was defined as the proportion of men with 1) metastases at diagnosis and 2) non-metastatic tumors whose cancers had low-, intermediate-, or high-risk features at diagnosis. Bivariate analyses were used to assess time trends in cancer severity.

This study found that unlike the broader US population, the proportion of disadvantaged men with organ-confined, low-risk prostate cancers has not been increasing. Thereby raising the question of whether public health programs addressing a single aspect of cancer control, in this case treatment only, represent an optimal strategy for addressing prostate cancer disparities across socioeconomic strata. So while much attention focuses on potential overdiagnosis and overtreatment of men with screen-detected prostate cancers, our findings suggest that–for low-income, uninsured men–underdetection and undertreatment remain significant concerns.

Learning Objectives:
1. Participants will be able to identify and discuss challenges faced by public-assistance programs designed to reduce cancer-related disparities. 2. Participants will be able to identify different explanations for the absence of risk migration men enrolled in a public health program. 3. Participants will be able to discuss implications for policies related to the development of public health programs addressing only one aspect of the cancer control continuum.

Keywords: Access to Care, Cancer

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was involved in conducting the research for this study and have presented at APHA in the past.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.