JU INSIGHT Prostate-specific Antigen Testing Behaviors for Prostate Cancer Screening Among U.S. Immigrants

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JU INSIGHT: Prostate-specific Antigen Testing Behaviors for Prostate Cancer Screening Among U.S. Immigrants

By: Nathaniel F. Hansen, BS; Joshua A. Linscott, MD, PhD; Matthew H. Hayn, MD; Stephen T. Ryan, MD; Jesse D. Sammon, DO | Posted on: 17 Jan 2023

Shu TD, Prunty MC, Pominville R, et al. Bladder and kidney cancer diagnosis and survival increase with Medicare eligibility at age 65. Urol Pract. 2023;10(1):59-65.

Study Need and Importance

As many as 25% of near-elderly adults have gaps in health care coverage prior to becoming eligible for Medicare at age 65. Previous studies have shown that lung, prostate, breast, and colon cancer diagnosis and survival increase at this age, which has been hypothesized to arise from increased health care utilization. The purpose of this study was to utilize Surveillance, Epidemiology, and End Results cancer registry data to determine if there was a similar “Medicare effect” for bladder and kidney cancers.

What We Found

The diagnosis of both bladder and kidney cancers spiked at age 65, a finding that was most apparent for locally staged cancers when stratifying by cancer stage. As shown in the Table, bladder cancer patients diagnosed at age 65 had greater cancer-specific survival compared to patients diagnosed at 66 and 69. Kidney cancer patients diagnosed at 65 had greater cancer-specific survival compared to patients diagnosed at 64, 66, 67, 68, and 69.

Table. 5-Year Cancer-Specific Mortality of Bladder and Kidney Cancer Patients Diagnosed From 2000 to 2013 From the Surveillance, Epidemiology, and End Results Database Stratified by Age at Diagnosis

	Bladder cancer			Kidney cancer
Age at diagnosis, y	Total diagnosed	Hazard ratio	P value	Total diagnosed	Hazard ratio	P value
60	3,685	0.97	.61	3,570	1.04	.42
61	4,006	1.01	.87	3,518	1.05	.35
62	4,166	0.96	.51	3,451	1.09	.1
63	4,184	1.04	.49	3,451	1.1	.07
64	4,353	1.02	.8	3,396	1.18	< .01
65	4,830	Reference	–	3,598	Reference	–
66	4,937	1.17	.01	3,342	1.14	.01
67	4,725	1.08	.16	3,283	1.16	.01
68	5,027	1.09	.11	3,193	1.23	< .01
69	4,932	1.18	.01	3,070	1.23	< .01

Limitations

While our data came from a large and nationally representative population, we lacked information regarding insurance status, which prevented direct comparisons between Medicare-eligible patients and uninsured Medicare-ineligible patients. This analysis lacked American Joint Committee on Cancer staging data, only providing the broader summary staging as classified by the Surveillance, Epidemiology, and End Results program, and relied on incomplete staging data, with more than 7% of bladder cancer patients and 9% of kidney cancer patients having unknown cancer stage.

Interpretation for Patient Care

We demonstrated an increase in diagnosis and survival for bladder and kidney cancer patients at age 65. Patients could be waiting until they become eligible for Medicare to utilize health care screenings, a delay that prevents earlier cancer diagnosis. The implication of this analysis is that expansion of Medicare eligibility may lead to significant improvements in bladder and kidney cancer outcomes, although such policy changes need further scrutiny.