Evaluation of Prostate Cancer Screening Strategies in a Low-Resource, High-Risk Population in the Bahamas

Eveline A.M. Heijnsdijk, Roman Gulati, Jane M. Lange, Alex Tsodikov, Robin Roberts, Ruth Etzioni

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Abstract

Importance The benefit of prostate-specific antigen screening may be greatest in high-risk populations, including men of African descent in the Caribbean. However, organized screening may not be sustainable in low- and middle-income countries.

Objective To evaluate the expected population outcomes and resource use of conservative prostate-specific antigen screening programs in the Bahamas.

Design, Setting, and Participants Prostate cancer incidence from GLOBOCAN and prostate-specific antigen screening data for 4300 men from the Bahamas were used to recalibrate 2 decision analytical models previously used to study prostate-specific antigen screening for Black men in the United States. Data on age and results obtained from prostate-specific antigen screening tests performed in Nassau from 2004 to 2018 and in Freeport from 2013 to 2018 were used. Data were analyzed from January 15, 2021, to March 23, 2022.

Interventions One or 2 screenings for men aged 45 to 60 years and conservative criteria for biopsy (prostate-specific antigen level >10 ng/mL) and curative treatment (Gleason score ≥8) were modeled. Categories of Gleason scores were 6 or lower, 7, and 8 or higher, with higher scores indicating higher risk of cancer progression and death.

Main Outcomes and Measures Projected numbers of tests and biopsies, prostate cancer (over)diagnoses, lives saved, and life-years gained owing to screening from 2022 to 2040.

Results In this decision analytical modeling study, screening histories from 4300 men (median age, 54 years; range, 13-101 years) tested between 2004 and 2018 at 2 sites in the Bahamas were used to inform the models. Screening once at 60 years of age was projected to involve 40 000 to 42 000 tests (range between models) and prevent 500 to 600 of 10 000 to 14 000 prostate cancer deaths. Screening at 50 and 60 years doubled the number of tests but increased lives saved by only 15% to 16%. Among onetime strategies, screening once at 60 years of age involved the fewest tests per life saved (74-84 tests) and curative treatments per life saved (1.2-2.8 treatments).

Conclusions and Relevance The findings of this decision analytical modeling study of prostate cancer screening in the Bahamas suggest that limited screening offered modest benefits that varied with screening ages and number of tests. The results can be combined with data on capacity constraints and evaluated relative to competing national public health priorities.
Original languageEnglish
Article numbere221116
Pages (from-to)E221116
Number of pages11
JournalJAMA Health Forum
Volume3
Issue number5
DOIs
Publication statusPublished - 20 May 2022

Bibliographical note

This work was supported by the NCI (U01CA199338, U01CA253915, P50CA97186, and R50CA221836). Dr Etzioni was also supported in part by the Rosalie and Harold Rea Brown Endowed Chair

Publisher Copyright:
© 2022 JAMA Health Forum. All right reserved.

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