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INTRODUCTION In October 1 992, the Cancer Committee ofthe North Carolina Medical Society established a pros-tate cancer task force. This group was charged with developing recommendations to increase the rate of early detection ofprostate cancers in North Carolin-ians. To help accomplish this mission, the task force requested the North Carolina Central Cancer Reg-istry (NC-CCR) to conduct a study of prostate cancer and the stage-at-diagnosis difference be-tween the races in North Carolina. At the Spring 1 993 meeting a preliminary report was presented to the membership. Based on that presentation, the NC-CCRwas directed to extend its study to include an analysis of survival differences for prostate can-cer. This is the report of that study. BACKGROUND American men have a 10 percent lifetime risk of developing clinically confirmed prostate cancer, making prostate cancer the most commonly diag-nosed malignancy in U.S. males. 1 In 1993, an esti-mated 1 65,000 American men were diagnosed with prostate cancer, while the disease killed approxi-mately 35,000. 2 Prostate cancer is the second lead-ing cause of cancer-related death among men in the United States. 3 For black men, prostate cancer poses even more of a threat. American blacks have the highest rate of prostate cancer in the world.4,5 Furthermore, in some areas of the country, the mortality rate among blacks is more that twice that observed in whites.6 North Carolina is one such area. When 5-year mortality data (1986-1 990) are adjusted to the age composition ofthe total state population, the death rate for black males is almost two and a half times that for whites (57.0/ 100,000 versus 23.2/1 00,000). 7'8 North Carolina has the highestprostate cancermortality rateamongblacks in the nation. 7 In 1 990, there were 320 prostate cancer deaths to blacks in North Carolina (who comprise 23 percent of the male population), compared to 643 deaths to whites. Stage-at-diagnosis appears to be a key factor contributing to the mortality differences between races. Several reports including some from North Carolina indicate that blacks tend to have more advanced cancer at the time ofdiagnosis. 8-9^ -"- 12 in 1990, about 25 percent of North Carolina blacks were diagnosed with distant disease compared with only 12 percent of whites. 8 Survival rates were substantially lower in men diagnosed with prostate cancer at distant versus localized stages. 13 - 14 However, survival rates depend not only on stage-at-diagnosis, but also on treatment and re-sponses to treatment. A handful ofstudies suggests that although stage-at-diagnosis is an important factor contributing to survival differences between blacks and whites, other factors that may influence survival include: 1) access to medical care and behavioral patterns that delay seeking treatment, 2) treatment preferences, 3) inherited tendency and 4) socioeconomic status. 11,14' 15' 16 A recent assessment has been completed on the attitudes and behavioral characteristics ofmen responding to prostate cancer screening programs in North Carolina. 17 These re-sults describe considerable reluctance to have pros-tate cancer screening tests, as well as substantial misunderstanding about the disease process. Also, there is variation in these findings by racial group. 17 The present report explores the discrepancy in prostate cancer-related survival between blacks and whites in North Carolina. METHODS This study analyzes survival patterns through 1992, of prostate cancer cases diagnosed in 1988. Because the NC-CCR does not actively follow cancer patients reported to it, survival information is obtained by matching the cancer incidence files with successive annual death files. 18 Since the NC-CCRpopulation- based coverage began in 1990, for this special study of prostate cancer survival the NC-CCR worked with cooperating hospital-based
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Full Text | INTRODUCTION In October 1 992, the Cancer Committee ofthe North Carolina Medical Society established a pros-tate cancer task force. This group was charged with developing recommendations to increase the rate of early detection ofprostate cancers in North Carolin-ians. To help accomplish this mission, the task force requested the North Carolina Central Cancer Reg-istry (NC-CCR) to conduct a study of prostate cancer and the stage-at-diagnosis difference be-tween the races in North Carolina. At the Spring 1 993 meeting a preliminary report was presented to the membership. Based on that presentation, the NC-CCRwas directed to extend its study to include an analysis of survival differences for prostate can-cer. This is the report of that study. BACKGROUND American men have a 10 percent lifetime risk of developing clinically confirmed prostate cancer, making prostate cancer the most commonly diag-nosed malignancy in U.S. males. 1 In 1993, an esti-mated 1 65,000 American men were diagnosed with prostate cancer, while the disease killed approxi-mately 35,000. 2 Prostate cancer is the second lead-ing cause of cancer-related death among men in the United States. 3 For black men, prostate cancer poses even more of a threat. American blacks have the highest rate of prostate cancer in the world.4,5 Furthermore, in some areas of the country, the mortality rate among blacks is more that twice that observed in whites.6 North Carolina is one such area. When 5-year mortality data (1986-1 990) are adjusted to the age composition ofthe total state population, the death rate for black males is almost two and a half times that for whites (57.0/ 100,000 versus 23.2/1 00,000). 7'8 North Carolina has the highestprostate cancermortality rateamongblacks in the nation. 7 In 1 990, there were 320 prostate cancer deaths to blacks in North Carolina (who comprise 23 percent of the male population), compared to 643 deaths to whites. Stage-at-diagnosis appears to be a key factor contributing to the mortality differences between races. Several reports including some from North Carolina indicate that blacks tend to have more advanced cancer at the time ofdiagnosis. 8-9^ -"- 12 in 1990, about 25 percent of North Carolina blacks were diagnosed with distant disease compared with only 12 percent of whites. 8 Survival rates were substantially lower in men diagnosed with prostate cancer at distant versus localized stages. 13 - 14 However, survival rates depend not only on stage-at-diagnosis, but also on treatment and re-sponses to treatment. A handful ofstudies suggests that although stage-at-diagnosis is an important factor contributing to survival differences between blacks and whites, other factors that may influence survival include: 1) access to medical care and behavioral patterns that delay seeking treatment, 2) treatment preferences, 3) inherited tendency and 4) socioeconomic status. 11,14' 15' 16 A recent assessment has been completed on the attitudes and behavioral characteristics ofmen responding to prostate cancer screening programs in North Carolina. 17 These re-sults describe considerable reluctance to have pros-tate cancer screening tests, as well as substantial misunderstanding about the disease process. Also, there is variation in these findings by racial group. 17 The present report explores the discrepancy in prostate cancer-related survival between blacks and whites in North Carolina. METHODS This study analyzes survival patterns through 1992, of prostate cancer cases diagnosed in 1988. Because the NC-CCR does not actively follow cancer patients reported to it, survival information is obtained by matching the cancer incidence files with successive annual death files. 18 Since the NC-CCRpopulation- based coverage began in 1990, for this special study of prostate cancer survival the NC-CCR worked with cooperating hospital-based |