Rates of prostate cancer screening lag in American Indian/Alaska Native population

American Indian and Alaska Native (AI/AN) men have lower rates of prostate-specific antigen (PSA) testing and digital rectal exams (DREs) compared with rates seen among non-Hispanic White men, according to findings recently published in Cancer Causes & Control.¹

Among AI/AN men, PSA tests were included in 1.67 visits per 100 visits, compared with 9.35 visits per 100 among White men between 2013 to 2016 and 2018.

“We found that American Indian and Alaska Native men were significantly less likely to receive a PSA than non-American Indian and Alaska Native men. The most alarming finding is that there were zero instances of DREs in the [National Ambulatory Medical Care Survey] (NAMCS) dataset over the entire 5-year period, and there were no PSAs conducted in American Indian/Alaska Native men after 2014,” said lead author Christopher M. Gillette, PhD, in a news release on the findings.² Gillette is an associate professor of PA studies at Wake Forest University School of Medicine.

For the study, the investigators conducted a secondary analysis of data from the NAMCS from 2013 to 2016 and 2018. This yielded a total of 509,737,580 cases, of which 232,998 were for American Indian/Alaska Native men. Further data were collected from the NAMCS Community Health Center (CHC) datasets from 2012 to 2015. Including this data yielded a total of 38,452,813 weighted visits, of which 320,189 were for AI/AN men.

The NAMCS data showed a statistically significant difference in rates of PSA testing and DREs among AI/AN men compared with non-Hispanic White men (aOR = 0.09).Among AI/AN men, PSA tests were included in 1.67 visits per 100 visits, compared with 9.35 visits per 100 among White men between 2013 to 2016 and 2018. Over the same time period, DREs were ordered for 0 visits per 100 in AI/AN men, compared with 2.52 visits per 100 among White men.

However, Gillette said in the news release, “We found that the disparity may not exist when men visit community health centers.”

In the CHC datasets, the data showed that PSA tests were included in 4.26 visits per 100 for AI/AN men, compared with 5.00 visits per 100 for White men. Similarly, DREs were included for 0.63 visits per 100 among AI/AN men, compared with 1.05 visits per 100 for White men. The difference in rates for PSA testing (OR = 0.91) and DREs (OR = 0.75) between AI/AN men and White men was not found to be statistically significant.

“More research is needed to better understand why,” Gillette added.

The investigators also noted that there were no PSAs conducted after 2014 among men included in the NAMCS database, along with 0 total DREs.

“Additional research is needed to explore how providers discuss PSA and DRE with this population, why there are differences in screening practices, and to examine access to care,” Gillette concluded in the news release.

References

1. Gillette C, Locklear T, Bell R, et al. American Indian/Alaska Native men are less likely to receive prostate-specific antigen testing and digital rectal exams from primary care providers than White men: a secondary analysis of the National Ambulatory Medical Care Survey from 2012-2018. Cancer Causes Control. Published online May 23, 2023. Accessed June 16, 2023. doi:10.1007/s10552-023-01714-x

2. American Indian and Alaska Native men less likely to receive prostate cancer screening. News release. Atrium Health Wake Forest Baptist. June 5, 2023. Accessed June 16, 2023. https://www.newswise.com/articles/american-indian-and-alaska-native-men-less-likely-to-receive-prostate-cancer-screening