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Localized prostate cancer disparities in risk group at presentation and access to treatment for Hispanic men

Abstract

Background

Despite great heterogeneity amongst Hispanic groups, prostate cancer studies often report Hispanic patients in aggregate. We sought to identify differences in prostate cancer risk group at presentation and treatment status among Hispanic subgroup populations.

Methods

Patients with localized prostate adenocarcinoma diagnosed from 2004–2017 were identified in the National Cancer Database (NCDB) and disaggregated by racial subgroup and Hispanic country of origin. Ordinal logistic regression defined adjusted odds ratios (AORs) with 95% CI of (1) presenting at progressively higher risk group and (2) receiving treatment with intermediate-unfavorable or high-risk disease.

Results

In our sample (n = 895,087), Hispanic men had greater odds of presenting with higher-risk localized prostate cancer compared with non-Hispanic White men (AOR = 1.18 95% CI 1.16–1.21, p < 0.001). Additionally, Hispanic Black men were less likely to present with higher-risk disease than non-Hispanic Black men. Disparities also existed when disaggregated by country of origin, particularly for Mexican men. Amongst men with unfavorable-risk disease, Hispanic men were less likely to receive treatment than non-Hispanic White men (95% CI 0.57–0.67, p < 0.001). The odds of Hispanic Black patients receiving treatment was 2.00 times the odds (95% CI 1.17–3.41 p = 0.011) of non-Hispanic Black patients receiving treatment. Upon disaggregation by country of origin, disparities persisted, particularly for Mexican men.

Conclusion

We found marked heterogeneity when risk group at presentation and treatment for higher-risk disease were disaggregated by racial subgroup and country of origin. Our findings support further collection of disaggregated data in Hispanic communities and study of potential mechanisms underlying the observed differences.

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Fig. 1: Differences in risk group at presentation among men with localized prostate cancer.
Fig. 2: Differences in treatment status among men with higher-risk localized prostate cancer.

Data availability

The patient-deidentified National Cancer Database is available from the American College of Surgeons (https://www.facs.org/quality-programs/cancer/ncdb/puf) and is not owned by the authors of this work.

Code availability

Stata code is available upon request from the first and/or corresponding author.

References

  1. Islami F, Ward EM, Sung H, Cronin KA, Tangka FKL, Sherman RL, et al. Annual report to the nation on the status of cancer, Part 1: National cancer statistics. Cancer. 2020;126:2225–49. https://doi.org/10.1002/cncr.32802

    Article  PubMed  Google Scholar 

  2. Dess RT, Hartman HE, Mahal BA, Soni PD, Jackson WC, Cooperberg MR, et al. Association of black race with prostate cancer–specific and other-cause mortality. JAMA Oncol. 2019;5:975–83. https://doi.org/10.1001/jamaoncol.2019.0826

    Article  PubMed  PubMed Central  Google Scholar 

  3. Jain B, Ng K, Santos PMG, Taparra K, Muralidhar V, Mahal BA, et al. Prostate cancer disparities in risk group at presentation and access to treatment for asian americans, native hawaiians, and pacific islanders: a study with disaggregated ethnic groups. JCO Oncol Pract 2021;28:OP2100412 https://doi.org/10.1200/OP.21.00412. Published online October

    Article  Google Scholar 

  4. Underwood W, De Monner S, Ubel P, Fagerlin A, Sanda MG, Wei JT. Racial/ethnic disparities in the treatment of localized/regional prostate cancer. J Urol. 2004;171:1504–7. https://doi.org/10.1097/01.ju.0000118907.64125.e0

    Article  PubMed  Google Scholar 

  5. Dee EC, Arega MA, Yang DD, Butler SS, Mahal BA, Sanford NN, et al. Disparities in refusal of locoregional treatment for prostate adenocarcinoma. JCO Oncol Pract 2021;17:e1489–e1501. https://doi.org/10.1200/OP.20.00839

    Article  PubMed  Google Scholar 

  6. Dee EC, Nezolosky MD, Chipidza FE, Arega MA, Butler SS, Sha ST, et al. Prostate cancer-specific mortality burden by risk group among men with localized disease: Implications for research and clinical trial priorities. Prostate. 2020;80:1128–33. https://doi.org/10.1002/pros.24041

    Article  PubMed  Google Scholar 

  7. Riviere P, Luterstein E, Kumar A, Vitzthum LK, Deka R, Sarkar RR, et al. Survival of African American and non-Hispanic white men with prostate cancer in an equal-access health care system. Cancer. 2020;126:1683–90. https://doi.org/10.1002/cncr.32666

    CAS  Article  PubMed  Google Scholar 

  8. Wen W, Luckenbaugh AN, Bayley CE, Penson DF, Shu XO. Racial disparities in mortality for patients with prostate cancer after radical prostatectomy. Cancer. 2021;127:1517–28. https://doi.org/10.1002/cncr.33152

    Article  PubMed  Google Scholar 

  9. Mahal BA, Alshalalfa M, Kensler KH, Chowdhury-Paulino I, Kantoff P, Mucci LA, et al. Racial differences in genomic profiling of prostate cancer. N Engl J Med 2020;383:1083–5. https://doi.org/10.1056/NEJMc2000069

    Article  PubMed  Google Scholar 

  10. Hales CM. Prevalence of obesity among adults and youth: United States, 2015–2016. 2017;8:1–8. https://pubmed.ncbi.nlm.nih.gov/29155689/.

  11. Mahal BA, Gerke T, Awasthi S, Soule HR, Simons JW, Miyahira A, et al. Prostate cancer racial disparities: a systematic review by the prostate cancer foundation panel. Eur Urol Oncol 2021;23:S2588–9311. https://doi.org/10.1016/j.euo.2021.07.006. Published online August(21)00146-2

    Article  Google Scholar 

  12. US Census Bureau. 2019 Population Estimates by Age, Sex, Race and Hispanic Origin. Census.gov. Accessed October 29, 2021. https://www.census.gov/newsroom/press-kits/2020/population-estimates-detailed.html

  13. Escarce JJ, Kapur K. Access to and Quality of Health Care. Hispanics and the Future of America. US: National Academies Press; 2006. https://www.ncbi.nlm.nih.gov/books/NBK19910/

    Google Scholar 

  14. Keisler-Starkey K, Bunch LN Health Insurance Coverage in the United States: 2019. US Census Bureau; 2020:60-271.

  15. Timmins CL. The impact of language barriers on the health care of Latinos in the United States: a review of the literature and guidelines for practice. J Midwifery Women’s Health 2002;47:80–96. https://doi.org/10.1016/s1526-9523(02)00218-0

    Article  Google Scholar 

  16. CDC. Cases, Data, and Surveillance. Centers for Disease Control and Prevention. Published February 11, 2020. Accessed October 29, 2021. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

  17. Weinick RM, Jacobs EA, Stone LC, Ortega AN, Burstin H. Hispanic healthcare disparities: challenging the myth of a monolithic Hispanic population. Med Care. 2004;42:313–20. https://doi.org/10.1097/01.mlr.0000118705.27241.7c

    Article  PubMed  Google Scholar 

  18. Siegel DA, O’Neil ME, Richards TB, Dowling NF, Weir HK. Prostate cancer incidence and survival, by stage and race/ethnicity — United States, 2001–2017. Morb Mortal Wkly Rep. 2020;69:1473–80. https://doi.org/10.15585/mmwr.mm6941a1

    Article  Google Scholar 

  19. Lee DJ, Zhao Z, Huang LC, Koyoma T, Resnick MJ, Penson DF, et al. Racial variation in receipt of quality radiation therapy for prostate cancer. Cancer Causes Control. 2018;29:895–9. https://doi.org/10.1007/s10552-018-1065-5

    Article  PubMed  Google Scholar 

  20. Miller KD, Ortiz AP, Pinheiro PS, Bandi P, Minihan A, Fuchs HE, et al. Cancer statistics for the US Hispanic/Latino population, 2021. CA Cancer J Clin. Published online September 21, 2021. https://doi.org/10.3322/caac.21695

  21. About the National Cancer Database. American College of Surgeons. Accessed October 29, 2021. https://www.facs.org/quality-programs/cancer/ncdb/about

  22. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280:969–74. https://doi.org/10.1001/jama.280.11.969

  23. Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options. J Urol 2018;199:683–90. https://doi.org/10.1016/j.juro.2017.11.095

    Article  PubMed  Google Scholar 

  24. Zumsteg ZS, Spratt DE, Pei I, Zhang Z, Yamada Y, Kollmeier M, et al. A new risk classification system for therapeutic decision making with intermediate-risk prostate cancer patients undergoing dose-escalated external-beam radiation therapy. Eur Urol. 2013;64:895–902. https://doi.org/10.1016/j.eururo.2013.03.033

    Article  PubMed  Google Scholar 

  25. Berlin A, Moraes FY, Sanmamed N, Glicksman R, Koven A, Espin-Garcia O, et al. International multicenter validation of an intermediate risk subclassification of prostate cancer managed with radical treatment without hormone therapy. J Urol 2019;201:284–91. https://doi.org/10.1016/j.juro.2018.08.044

    Article  PubMed  Google Scholar 

  26. Meghani SH, Chittams J. Controlling for socioeconomic status in pain disparities research: all-else-equal analysis when “all else” is not equal. Pain Med Malden Mass. 2015;16:2222–5. https://doi.org/10.1111/pme.12829

    Article  Google Scholar 

  27. Nuru-Jeter AM, Michaels EK, Thomas MD, Reeves AN, Thorpe RJ, LaVeist TA. Relative roles of race versus socioeconomic position in studies of health inequalities: a matter of interpretation. Annu Rev Public Health. 2018;39:169–88. https://doi.org/10.1146/annurev-publhealth-040617-014230

    Article  PubMed  Google Scholar 

  28. VanderWeele TJ, Robinson WR. On the causal interpretation of race in regressions adjusting for confounding and mediating variables. Epidemiol Camb Mass 2014;25:473–84. https://doi.org/10.1097/EDE.0000000000000105

    Article  Google Scholar 

  29. Siegel RL, Fedewa SA, Miller KD, Goding-Sauer A, Pinheiro PS, Martinez-Tyson D, et al. Cancer statistics for Hispanics/Latinos, 2015. CA Cancer J Clin 2015;65:457–80. https://doi.org/10.3322/caac.21314

    Article  PubMed  Google Scholar 

  30. Banegas MP, Li CI. Breast cancer characteristics and outcomes among Hispanic Black and Hispanic White women. Breast Cancer Res. Treat. 2012;134:1297–304. https://doi.org/10.1007/s10549-012-2142-1

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ooi SL, Martinez ME, Li CI. Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Res. Treat. 2011;127:729–38. https://doi.org/10.1007/s10549-010-1191-6

    Article  PubMed  Google Scholar 

  32. Pernar CH, Ebot EM, Wilson KM, Mucci LA. The epidemiology of prostate cancer. Cold Spring Harb Perspect Med 2018;8:a030361 https://doi.org/10.1101/cshperspect.a030361

    Article  PubMed  PubMed Central  Google Scholar 

  33. Haque R, Van Den Eeden SK, Jacobsen SJ, Caan B, Avila CC, Slezak J, et al. Correlates of prostate-specific antigen testing in a large multiethnic cohort. Am J Manag Care 2009;15:793–9.

    PubMed  Google Scholar 

  34. Hosain GMM, Sanderson M, Du XL, Chan W, Strom SS. Racial/ethnic differences in predictors of PSA screening in a tri-ethnic population. Cent Eur J Public Health 2011;19:30–34. https://doi.org/10.21101/cejph.a3622

    Article  PubMed  PubMed Central  Google Scholar 

  35. Zhou J, Enewold L, Peoples GE, McLeod DG, Potter JF, Steele SR, et al. Colorectal, prostate, and skin cancer screening among Hispanic and White non-Hispanic men, 2000-2005. J Natl Med Assoc 2011;103:343–50. https://doi.org/10.1016/s0027-9684(15)30315-1

    Article  PubMed  Google Scholar 

  36. Reyes-Ortiz CA, Camacho ME, Amador LF, Velez LF, Ottenbacher KJ, Markides KS. The impact of education and literacy levels on cancer screening among older Latin American and Caribbean adults. Cancer Control J Moffitt Cancer Cent 2007;14:388–95. https://doi.org/10.1177/107327480701400409

    Article  Google Scholar 

  37. Coronado G, Thompson B. Rural Mexican American men’s attitudes and beliefs about cancer screening. J Cancer Educ J Am Assoc Cancer Educ 2000;15:41–45. https://doi.org/10.1080/08858190009528652

    CAS  Article  Google Scholar 

  38. Eckstrand KL, Eliason J, St. Cloud T, Potter J. The priority of intersectionality in academic medicine. Acad Med. 2016;91:904–7. https://doi.org/10.1097/ACM.0000000000001231

    Article  PubMed  Google Scholar 

  39. Givens ML, Gennuso KP, Pollock EA, Johnson SL. Deconstructing inequities - transparent values in measurement and analytic choices. N Engl J Med 2021;384:1861–5. https://doi.org/10.1056/NEJMms2035717

    Article  PubMed  Google Scholar 

  40. Stern MC Prostate Cancer in US Latinos: What Have We Learned and Where Should We Focus Our Attention. In: Ramirez AG, Trapido EJ, eds. Advancing the Science of Cancer in Latinos. Springer International Publishing; 2020:57-67. https://doi.org/10.1007/978-3-030-29286-7_5

  41. Salari K, Choudhry S, Tang H, Naqvi M, Lind D, Avila PC, et al. Genetic admixture and asthma-related phenotypes in Mexican American and Puerto Rican asthmatics. Genet Epidemiol. 2005;29:76–86. https://doi.org/10.1002/gepi.20079

    Article  PubMed  Google Scholar 

  42. Stern MC, Fejerman L, Das R, Setiawan VW, Cruz-Correa MR, Perez-Stable EJ, et al. Variability in cancer risk and outcomes within US Latinos by national origin and genetic ancestry. Curr Epidemiol Rep. 2016;3:181–90. https://doi.org/10.1007/s40471-016-0083-7

    Article  PubMed  PubMed Central  Google Scholar 

  43. Alcántara C, Chen CN, Alegría M. Do post-migration perceptions of social mobility matter for Latino immigrant health? Soc Sci Med 1982. 2014;101:94–106. https://doi.org/10.1016/j.socscimed.2013.11.024

    Article  Google Scholar 

  44. Alegría M, Canino G, Shrout PE, Woo M, Duan N, Vila D, et al. Prevalence of mental illness in immigrant and non-immigrant U.S. Latino groups. Am J Psychiatry 2008;165:359–69. https://doi.org/10.1176/appi.ajp.2007.07040704

    Article  PubMed  PubMed Central  Google Scholar 

  45. Cabassa LJ Community mental health services to Latinos. In: Community Mental Health: Challenges for the 21st Century, 2nd Ed. Routledge/Taylor & Francis Group; 2013:162–78.

  46. Alcántara C, Cabassa LJ, Suglia S, Ibarra IP, Falzon AL, McCullough E, et al. Disaggregating Latina/o Surveillance Health Data Across the Lifecourse: Barrriers, Facilitators, and Examplars. Robert Wood Johnson Foundation; 2017:68.

  47. Daviglus ML, Talavera GA, Avilés-Santa ML, Allison M, Cai J, Criqui MH, et al. Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. JAMA. 2012;308:1775–84. https://doi.org/10.1001/jama.2012.14517

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  48. Dominguez K, Penman-Aguilar A, Chang MH, Moonesinghe R, Castellanos T, Rodriguez-Lainz A, et al. Vital signs: leading causes of death, prevalence of diseases and risk factors, and use of health services among Hispanics in the United States - 2009-2013. MMWR Morb Mortal Wkly Rep. 2015;64:469–78.

    PubMed  PubMed Central  Google Scholar 

  49. Kaestner R, Pearson JA, Keene D, Geronimus AT. Stress, allostatic load and health of Mexican immigrants. Soc Sci Q. 2009;90:1089–111. https://doi.org/10.1111/j.1540-6237.2009.00648.x

    Article  PubMed  PubMed Central  Google Scholar 

  50. LaVeist-Ramos TA, Galarraga J, Thorpe RJ, Bell CN, Austin CJ. Are black Hispanics black or Hispanic? Exploring disparities at the intersection of race and ethnicity. J Epidemiol Community Health. 2012;66:e21 https://doi.org/10.1136/jech.2009.103879

    Article  PubMed  Google Scholar 

  51. Champion CD, Thomas SM, Plichta JK, Parrilla Castellar E, Rosenberger LH, Greenup RA, et al. Disparities at the Intersection of Race and Ethnicity: Examining Trends and Outcomes in Hispanic Women With Breast Cancer. JCO Oncol Pract. Published online October 7, 2020:OP.20.00381. https://doi.org/10.1200/OP.20.00381

  52. Wilson Y, White A, Jefferson A, Danis M. Intersectionality in clinical medicine: the need for a conceptual framework. Am J Bioeth 2019;19:8–19. https://doi.org/10.1080/15265161.2018.1557275

    Article  PubMed  Google Scholar 

  53. López N, Vargas E, Juarez M, Cacari-Stone L, Bettez S. What’s your “street race”? leveraging multidimensional measures of race and intersectionality for examining physical and mental health status among Latinxs. Socio Race Ethn 2018;4:49–66. https://doi.org/10.1177/2332649217708798

    Article  Google Scholar 

  54. Racism is a Public Health Crisis. Accessed November 3, 2021. https://www.apha.org/topics-and-issues/health-equity/racism-and-health/racism-declarations

  55. Dobbs RW, Malhotra NR, Abern MR, Moreira DM. Prostate cancer disparities in Hispanics by country of origin: a nationwide population-based analysis. Prostate Cancer Prostatic Dis. 2019;22:159–67. https://doi.org/10.1038/s41391-018-0097-y

    CAS  Article  PubMed  Google Scholar 

  56. Chinea FM, Patel VN, Kwon D, Lamichhane N, Lopez C, Punnen S, et al. Ethnic heterogeneity and prostate cancer mortality in Hispanic/Latino men: a population-based study. Oncotarget. 2017;8:69709–21. https://doi.org/10.18632/oncotarget.19068

    Article  PubMed  PubMed Central  Google Scholar 

  57. Arega MA, Yang DD, Royce TJ, Mahal BA, Dee EC, Butler SS, et al. Association between travel distance and use of postoperative radiation therapy among men with organ-confined prostate cancer: does geography influence treatment decisions? Pr Radiat Oncol. 2021;11:e426–e433. https://doi.org/10.1016/j.prro.2020.12.002

    Article  Google Scholar 

  58. Dee EC, Muralidhar V, Arega MA, Kishan AU, Spratt DE, Dess RT, et al. Factors influencing noncompletion of radiation therapy among men with localized prostate cancer. Int J Radiat Oncol Biol Phys 2021;109:1279–85. https://doi.org/10.1016/j.ijrobp.2020.11.064

    Article  PubMed  Google Scholar 

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Funding

BAM is funded by the Prostate Cancer Foundation and (PCF), the American Society for Radiation Oncology (ASTRO), the Department of Defense, and the Sylvester Comprehensive Cancer Center. IF is funded in part through a Diversity Supplement from the Center to Reduce Cancer Health Disparities, National Cancer Institute, National Institutes of Health. KN has received funding from Tesaro, Pfizer, Boehringer, Ingelheim, GlaxoSmithKline UK Ltd, and Conquer Cancer Foundation outside the submitted work. ND has received funding from AstraZeneca, Merck, Pfizer, BMS, Genentech, BI Oncology, Janssen, and Neogenomics outside the submitted work. KY reported support from Flatiron Inc and Janssen R&D outside the submitted work. PLN reported receiving grants and personal fees from Bayer, Janssen, and Astellas and personal fees from Boston Scientific, Dendreon, Ferring, COTA, Blue Earth Diagnostics, and Augmenix outside the submitted work; PLN is also funded in part through the NIH Grant R01-CA240582. ECD is funded in part through the NIH/NCI Support Grant P30 CA008748.

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NS, ECD, and BAM had full access to all the data and had final responsibility for the decision to submit this article for publication. Concept and Design: All authors. Acquisition, analysis, interpretation of data: All authors. Drafting of the manuscript: NS, ECD, TN, and KM. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: NS and ECD.

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Correspondence to Brandon A. Mahal or Edward Christopher Dee.

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Swami, N., Baez, Y.A., Franco, I. et al. Localized prostate cancer disparities in risk group at presentation and access to treatment for Hispanic men. Prostate Cancer Prostatic Dis (2022). https://doi.org/10.1038/s41391-022-00526-5

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