Health Practices of Male Department of Defense Health Care Beneficiaries: A Follow-Up on Prostate Cancer Screening in the National Capital Area

Military Medicine, Dec 2003 by Boyles, Gerald, Moore, Angelo Dewitt, Edwards, Quannetta T

The purpose of this study was to assess screening for prostate cancer (PC) of male Department of Defense health care beneficiaries in the national capital area. This study was a follow-up of a previous research of African-American men's PC screening practices. In the previous study, 85% of African-American men screened for PC and the determinants of screening were men's perceived "benefits" of PC testing, age, and education. This follow-up study was conducted on 234 men age 52 years and over regardless of ethnicity using a questionnaire and convenience sampling similar to the prior study. Results showed 96% screened for PC; no statistical differences in PC screening and ethnicity; and men's perceived "self-efficacy" and "benefits" were predictors of PC screening. More men screened for PC when advised by their health care providers and 94% of men stated "trust" in health care providers, indicating the importance of a "trusting-informative health care milieu" for men's self-efficacy to screen for PC.

Introduction

In a previous study by Edwards et al.1 that assessed African-American men's (AAM) prostate cancer (PC) screening practices at military health care facilities, the researchers found high rates of screening practices among this group of men (85%). Besides the rate of PC screening practices, the previous study assessed age, knowledge, education, and perceptions of the health belief model (HBM) as potential factors that differentiated screening frequency for PC among AAM. Using the HBM as an framework of study, factors assessed that influenced screening included men's perceived (1) seriousness and susceptibility to PC (threats); (2) benefits; (3) barriers; and (4) self-efficacy to obtain PC screening. Data from the Edwards et al.'s1 study revealed that AAM's perceptions of benefits of testing with the digital rectal examination (DRE) and prostate-specific antigen (PSA) test as well as demographic factors of age and education differentiated PC screening behaviors.1 Perceived benefits of testing, however, best predicted AAM's PC screening practices. The study concluded with recommendations to further assess screening practices on men regardless of ethnicity to see whether similar high rates of PC screening existed within the military setting and to determine whether predictors for screening were comparable. Thus, the purposes of this study were to describe PC screening practices and to determine predictor(s) that differentiated frequency of screening practices among Department of Defense (DoD) health care beneficiaries in the national capital area (NCA). This study assessed men regardless of ethnicity based on the recommendations of the study conducted by Edwards et al.1 The following research questions were assessed in this study regarding DoD beneficiaries of health care in the NCA: (1) What percentage of men screen for PC? (2) What are their PC screening frequency patterns? (3) Are there statistically significant differences in ethnicity regarding PC screening practices? (4) Which factor(s) differentiate their PC frequency patterns?

Why Assess PC Screening Practices?

According to the American Cancer Society (ACS), approximately 33% of cancers to be diagnosed in men during the year 2003 will occur in the prostate, resulting in PC as the leading cause for cancer in men.2 Statistics from the ACS reveal estimates of 220,900 cases of PC occurring during 2003, and as many as 28,900 men will die from the disease during the same year.2 PC most often occurs in older men. In fact, 70% of all PCs are diagnosed in men over the age of 65 years.2 Besides age, additional risk factors for PC include family history and race. Family history of PC may account for as much as 5 to 10% of PCs,2 and AAM have the highest incidence rates of PC in the world.2,3 Specific incidence rates of PC are 275.3 per 100,000 for AAM, 172.9 per 100,000 for Caucasians, and lower for Hispanic and Asian Pacific Islanders with rates noted as 127.6 and 107.2 per 100,000 respectively.2

Because of these alarming statistics regarding PC, early detection through screening is recommended by many professional organizations such as the ACS and the American Urological Association.2,4 Organizations like the ACS recommends that early detection with screening be offered annually to men beginning at age 50 years and earlier (age 45 years) for men at high risk (AAM and men who have a first-degree relative with PC).2 Two procedures, the DRE and the blood test PSA, are currently recommended for PC screening. Early detection of PC while the tumor is still confined to the prostate, according to some, may lead to a 90% survival rate compared with 35% for a more advanced disease.5 Statistical data on incidence rates of PC are important to the health of DoD beneficiaries because an increased number of newly diagnosed prostate tumors reported from 1990 to 1993 noted by Allerton et al.6 revealed a financial impact of the disease on the DoD.

It would be remiss to state that screening for PC is recommended by all professional organizations. In fact, The United States Preventive Services Task Force found good evidence that PSA screening can detect early-stage prostate cancer but mixed and inconclusive evidence that early detection improves health outcomes and thus the United States Preventive Services Task Force concludes that evidence is insufficient to determine whether the benefits outweigh the harms for a screened population.8 Studies are currently underway by the National Cancer Institute through randomized clinical trials known as the Prostate, Lung, Colorectal, and Ovarian Screening Trial that should shed some light on the benefits of screening regarding reducing mortality, however the results of these finding are not projected to be available until after year 2007.9,1O