Global patterns of prostate cancer incidence, aggressiveness, and mortality in men of african descent

Abstract

Prostate cancer (CaP) is the leading cancer among men of African descent in the USA, Caribbean, and Sub-Saharan Africa (SSA). The estimated number of CaP deaths in SSA during 2008 was more than five times that among African Americans and is expected to double in Africa by 2030. We summarize publicly available CaP data and collected data from the men of African descent and Carcinoma of the Prostate (MADCaP) Consortium and the African Caribbean Cancer Consortium (AC3) to evaluate CaP incidence and mortality in men of African descent worldwide. CaP incidence and mortality are highest in men of African descent in the USA and the Caribbean. Tumor stage and grade were highest in SSA. We report a higher proportion of T1 stage prostate tumors in countries with greater percent gross domestic product spent on health care and physicians per 100,000 persons. We also observed that regions with a higher proportion of advanced tumors reported lower mortality rates. This finding suggests that CaP is underdiagnosed and/or underreported in SSA men. Nonetheless, CaP incidence and mortality represent a significant public health problem in men of African descent around the world.

Figure 1

Estimates of CaP incidence (1990–2008) per 100,000 men of African descent, age-standardized to the 1960 world Population. Incidence rates for the USA are from SEER-13 for 1992–2008; data for 2008 include one estimate from each of the SEER-17 registries, except two registries with <16 cases. Incidence rates for all Caribbean countries are from 2008 GLOBOCAN data. Incidence rates for African countries are from specific population-based cancer registries for 1990–2004 and from 2008 GLOBOCAN data. Rates can be found in Supplementary Table 1. Incidence rates are age-standardized to the 1960 world population.

Figure 2

Estimates of 2008 CaP mortality per 100,000 men, age-standardized to the 1960 world population. African American data are from states with at least one SEER-17 cancer registry (excluding states with fewer than 10 CaP deaths), African and Caribbean data are from GLOBOCAN 2008.

Figure 3

Relationship of prostate tumor aggressiveness with CaP incidence, mortality, and health care-related statistics in men of African descent. % T1 stage tumor data from the MADCaP and AC3 Consortia. (a) Percent of tumors diagnosed at T1 stage by PCa incidence (per 100,000 population). Age-standardized incidence rates from 2008 GLOBOCAN and 2008 SEER-17 cancer registries (San Francisco-Oakland, San Jose/Monterey, and Los Angeles, California; Connecticut; Detroit; Louisiana; New Jersey). (b) Percent of tumors diagnosed at T1 stage by percent of gross domestic product spent on health Care. Sources of percent of gross domestic product spent on health care: (1) Outside USA: WHO World Health Statistics 2010 (http://www.who.int/whosis/whostat/EN_WHS10_Full.pdf); (2) USA: Centers for Medicare and Medicaid Services (https://www.cms.gov) by state. (c) Percent of tumors diagnosed at T1 stage by number of physicians per 10,000 persons. Sources of data on physicians per 10,000 persons: (1) Outside USA: WHO World Health Statistics 2010 (http://www.who.int/whosis/whostat/EN_WHS10_Full.pdf); (2) USA (by state): Dionne, M., Moore, J., Armstrong, D., Martiniano, R. (2006) The United States health workforce profile. Rensselaer, NY: Center for Health Workforce Studies, School of Public Health, SUNY Albany. (d) percent of tumors diagnosed at T1 stage by CaP mortality (per 100,000 population). Mortality data for 2006 from CDC Wonder Database (http://wonder.cdc.gov/).