Recent findings from a study of prostate cancer in Ireland reveal disparities in diagnosis, especially in urban areas and middle socio-economic groups. Patients treated in public hospitals and urban patients were most often diagnosed through opportunistic screening.
This recent study characterized disease presentation, identified factors associated with socio-demographic inequalities in presentation following opportunistic screening and shed light on potential challenges of inequality in Ireland’s healthcare structure. Addressing these gaps in the healthcare system can guide future strategies for equitable early detection.
Prostate cancer is the most commonly diagnosed cancer in men in Ireland. It accounts for almost 30% of all cancer cases in men. There were 3,980 cases diagnosed on average each year from 2019 to 2021 (source: National Cancer Registry of Ireland). This translates to a 1 in 9 (11%) risk of developing prostate cancer before age 75.
Early detection of prostate cancer is crucial to improving outcomes and survival rates. The Irish Prostate Cancer Research Group (IPCOR) led by Associate Clinical Professor David Galvin, UCD School of Medicine, Mater & St Vincent Hospitals, supported by the Irish Cancer Society and the Movember Foundation, is focusing on improving the care of of prostate cancer in Ireland by creating a comprehensive national database, assessing quality of care and evaluating patient experiences.
To do this, the IPCOR project collected data on the demographics, diagnosis and treatment of 6,816 men newly diagnosed with prostate cancer in 16 hospitals in the Republic of Ireland from February 2016 to January 2020. They the men were examined at the urology clinic after a random screening.
Opportunistic prostate cancer screening refers to the practice of screening for the disease (usually with a blood test called a PSA test) in men who visit their health care providers for unrelated reasons. It does not refer to trials following clinical findings or as part of a screening program.
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in the blood.
This study provides a comprehensive national analysis of prostate cancer presentation differences in Ireland, covering rural and urban populations and public versus private healthcare sectors.
Hospital type was a determinant of urology clinic attendance after opportunistic screening. Patients in public hospitals are 45.7% more likely to present after screening compared to those in private hospitals.
Urban residents were 34% more likely to be seen after screening than rural residents. However, patients in urban areas are diagnosed with more advanced prostate cancer. One possible explanation for this is that urban healthcare systems are burdened by longer waiting times, particularly in the public sector, leading to delays in both diagnosis and treatment.
The findings highlight the impact of disparities in access to health care, particularly for middle socioeconomic groups and rural populations, on the incidence of prostate cancer after opportunistic screening. They highlight the need for targeted interventions to improve access to health care, offering useful insights for policy makers and health care providers.
Commenting on the study, Professor David Galvin said: “By addressing these differences in access to healthcare, socio-economic status and urban versus rural housing, in addition to implementing tailored strategies, we can work towards closing inequalities in prostate cancer care, ultimately leading to improved health outcomes and equity across all segments of the population.”
This study contributes to the wider global debate on healthcare equity in cancer detection, particularly in countries with mixed public-private healthcare systems such as Ireland.”
Professor William Watson, co-investigator and Conway Fellow, UCD School of Medicine
Dr. Noa Gordon, who is a member of the IPCOR team, conducted this research as part of her Janssen-Movember Newman postdoctoral fellowship.
Source:
Journal Reference:
Gordon, N., et al. (2024). Are we there yet? Closing the gap in prostate cancer presentation differences in Ireland. Public Health Archives. doi.org/10.1186/s13690-024-01439-6.
