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. 2016 Mar 2;4(1):E73-9.
doi: 10.9778/cmajo.20140079. eCollection 2016 Jan-Mar.

Trends in prostate cancer incidence and mortality in Canada during the era of prostate-specific antigen screening

James Dickinson  1 , Amanda Shane  1 , Marcello Tonelli  1 , Sarah Connor Gorber  1 , Michel Joffres  1 , Harminder Singh  1 , Neil Bell  1
Affiliations

Trends in prostate cancer incidence and mortality in Canada during the era of prostate-specific antigen screening

James Dickinson et al. CMAJ Open. .

Abstract

Background: Widespread use of prostate-specific antigen (PSA) to screen for prostate cancer began in the early 1990s. Advocates for screening assert that this has caused a decrease in prostate cancer mortality. We sought to describe secular changes in prostate cancer incidence and mortality in Canada in relation to the onset of PSA screening.

Methods: Age-standardized and age-specific prostate cancer incidence (1969-2007) and mortality (1969-2009) from Public Health Agency of Canada databases were analyzed by joinpoint regression. Changes in incidence and mortality were related to introduction of PSA screening.

Results: Prior to PSA screening, prostate cancer incidence increased from 54.2 to 99.8 per 100 000 between 1969 and 1990. Thereafter, incidence increased sharply (12.8% per year) to peak at 140.8/100 000 in 1993. After decreasing in all age groups between 1993 and 1996, incidence continued to increase for men aged less than 70 years, but decreased for older men. Age-standardized mortality was stable from 1969 to 1977, increased 1.4% per year to peak in 1995 and subsequently decreased at 3.3% per year; the decline started from 1987 in younger men (age < 60 yr).

Interpretation: Incidence was increasing before PSA screening occurred, but rose further after it was introduced. Reductions in prostate cancer mortality began before PSA screening was widely used and were larger than could be anticipated from screening alone. These findings suggest that screening caused artifactual increase in incidence, but no more than a part of reductions in prostate cancer mortality. The reduction may be due to changing treatment or certification of death.

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Conflict of interest statement

Competing interests: All authors were members of the Canadian Task Force on Preventive Health Care or its support group in the Public Health Agency of Canada at the time of writing this paper. All of the authors wrote the task force report on prostate cancer screening.

Figures

Figure 1
Figure 1
Age-standardized incidence and mortality, number of cases and deaths from prostate cancer, 1969-2009, Canada.
Figure 2
Figure 2
Age-standardized incidence (per 100 000) and annual percent change (APC) of prostate cancer incidence, 1969-2007, Canada.
Figure 3
Figure 3
Incidence of prostate cancer by age group, 1969-2007, Canada.
Figure 4
Figure 4
Age-standardized mortality (per 100 000) and annual percent change (APC) of prostate cancer mortality, 1969-2009, Canada.
Figure 5
Figure 5
Mortality by age group, 1969-2009, Canada.
See this image and copyright information in PMC

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