Earlier age at diagnosis: Another dimension in cancer disparity?
Introduction
The age at cancer diagnosis is of vital consideration for maximizing the benefits of screening recommendations, prevention initiatives, and treatment strategies. The U.S. Preventive Services Task Force, for instance, has recommended that PSA testing begin in AA men at age 45 and in white men at age 50 because AA men have an earlier diagnosis of prostate cancer than whites. Furthermore, cancers that arise at a younger age tend to be more aggressive, may be found at a more advanced stage, and frequently result in a less favorable outcome than cancers that develop later in life [1]. Differences regarding age at diagnosis have been observed among different racial/ethnic populations in the U.S. [2], [3], [4]. According to the Surveillance, Epidemiology, and End Results (SEER) Program, AA women below the age of 42 have higher rates of breast cancer than white women [5]. From 1996 to 2000, the median age at diagnosis for invasive breast cancer for white women was 64 years, and for AA women it was 57 years [5]. AA men have higher rates of prostate cancer at a younger age than white men [6]. AA are 2 to four times more likely than whites to be diagnosed before the age of 50 for all head and neck cancers except those arising in the salivary glands [7]. The median age at diagnosis for multiple myeloma is also lower in AA than whites (67 years compared with 71 years) [8]. Based on the observations that a number of cancers are diagnosed at an earlier age in AA than in whites, we wanted to determine whether early diagnosis was limited to a few common cancers or whether it was a more general characteristic of cancer in AA.
Nearly all investigators comparing age at cancer diagnosis in different populations have used the median age at diagnosis. However, this method does not take into account the differences in the age distributions in different populations. Therefore, to more fully investigate the age at cancer diagnosis between AA and whites, we compared the median age at diagnosis to two other methods.
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Materials and methods
The SEER Program of the National Cancer Institute provided all cancer data for this study [5]. SEER collects and publishes cancer incidence and survival data from approximately 14% of the population [5]. Data concerning patient demographics, diagnosis, stage of disease, morphology, primary tumor site, and follow-up for vital status between 1973 and 2002 identify changing trends and racial/ethnic disparities for all cancer sites. Information pertaining to patients’ race/ethnicity from the SEER
Median age at diagnosis
Table 1 shows the results for the median age at diagnosis for the 12 most common cancers for both AA and whites. The median age at diagnosis for AA was earlier for all of the 12 most frequently occurring cancers. Odds ratios of less than one indicate that AA are more likely than whites to receive a diagnosis of cancer before the median age of the total population. The median age at diagnosis in the total population for each cancer (AA plus whites) is also listed in Table 1.
Age at diagnosis at ≥3 cases per 100,000 persons
Table 2 illustrates
Discussion
According to the median age, the 12 most commonly occurring cancers recorded from 1996 to 2002 were diagnosed significantly earlier in AA than in whites. This was evident even when we examined the median age at diagnosis for all sites combined. The white population had a 4-year greater median age at diagnosis, 68 years, compared with the AA population, 64 years [5]. Even more evident was the younger median age at diagnosis for all cancer sites combined in AA females; white females had a 5-year
Conflict of interest
None.
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