Oncology - Prostate
Introduction & Objective : Prostate cancer (CaP) is an epidemiologically complex disease with heterogeneous incidence and mortality. In global CaP epidemiology, the influence of health systems-level factors on disease burden is unclear. This study examines how cancer surveillance programs and policies of national health infrastructures impact the global burden of CaP.
Methods : We queried the Cancer Atlas, a global cancer database of the World Health Organization and American Cancer Society, for structural and socioeconomic variables pertinent to CaP in national health systems. We performed Pearson correlations and multiple regression analyses using these variables and country-specific rates of CaP incidence and mortality.
Results : We analyzed CaP incidence and mortality rates reported by 187 national health systems. Country-specific incidence was strongly positively correlated with the quality of population-based cancer registries (PBCR), which collect and measure surveillance statistics (P<0.001). Having a national high-quality PBCR (vs. regional high-quality or lesser quality) was the strongest predictor of CaP incidence among all structural and socioeconomic variables (Fig. 1A; P<0.001). Health systems with cancer control policies had lower rates of CaP mortality. For instance, mortality was negatively correlated with the extent of warning labels on cigarette packaging (as a proxy for cancer prevention programs) (P<0.001); mean mortality was 11.7 and 11.8/100,000 for countries with medium and large labels, respectively, vs. 17.8/100,000 for small/no labels (Fig. 1B). CaP mortality was also lower in countries with vs. without an operational national cancer control strategy (Fig. 1C; 13.1 vs. 16.3/100,000, P=0.05).
Conclusions : Although the substantially higher incidence of CaP in countries with a high-quality PBCR may reflect differences in screening practices, a portion may be explained by a decreased capture of clinically-significant CaP in countries with regional-only or lower quality PBCR. Given the heterogeneity of this disease and diverse national healthcare priorities, the significance of these findings warrants further study.