ESMO real world data and digital oncology · 2026
Socioeconomic differences in prostate cancer diagnosis and stage following the introduction of Rapid Access Prostate Clinics in Ireland.
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Haugh C, Walter S, Sweeney P, McDevitt J, Murray D, Redaniel M T
Аннотация
BACKGROUND: Rapid Access Prostate Clinics (RAPCs) were introduced in Ireland in 2009 to centralise and standardise prostate cancer (PCa) diagnosis within designated cancer centres. While RAPCs aim to improve diagnostic organisation following general practitioner referral, access remains influenced by socioeconomic differences in prostate-specific antigen testing and referral patterns. We examined changes in PCa incidence and stage at diagnosis following RAPC implementation and whether trends differed across socioeconomic groups.
PATIENTS AND METHODS: Using population-based data from the National Cancer Registry Ireland, we identified men aged 50-70 years diagnosed with PCa between 2000 and 2022. Socioeconomic status was assigned using the Pobal Haase-Pratschke Deprivation Index. Interrupted time-series analyses using negative binomial regression compared trends before (2000-2008) and after (2009-2022) RAPC implementation. Analyses were conducted by deprivation quintile and tumour stage, with sensitivity analyses restricted to cancer centres.
RESULTS: A total of 44 127 cases were identified. Before RAPC implementation, quarterly incidence estimates increased across all socioeconomic groups. Following implementation, incidence trends stabilised, with a decline in the most deprived group. Early-stage (I and II) incidence was most affected, stabilising or decreasing, particularly among more deprived groups, while stages III and IV incidence rates showed modest increases following implementation, with limited socioeconomic variation.
CONCLUSIONS: RAPC implementation coincided with stabilisation of PCa incidence following a period of rising diagnoses. However, it did not reduce late-stage presentations or eliminate socioeconomic differences in stage at presentation. These findings suggest that centralisation of diagnostic services alone is insufficient in achieving equity in PCa detection.
PATIENTS AND METHODS: Using population-based data from the National Cancer Registry Ireland, we identified men aged 50-70 years diagnosed with PCa between 2000 and 2022. Socioeconomic status was assigned using the Pobal Haase-Pratschke Deprivation Index. Interrupted time-series analyses using negative binomial regression compared trends before (2000-2008) and after (2009-2022) RAPC implementation. Analyses were conducted by deprivation quintile and tumour stage, with sensitivity analyses restricted to cancer centres.
RESULTS: A total of 44 127 cases were identified. Before RAPC implementation, quarterly incidence estimates increased across all socioeconomic groups. Following implementation, incidence trends stabilised, with a decline in the most deprived group. Early-stage (I and II) incidence was most affected, stabilising or decreasing, particularly among more deprived groups, while stages III and IV incidence rates showed modest increases following implementation, with limited socioeconomic variation.
CONCLUSIONS: RAPC implementation coincided with stabilisation of PCa incidence following a period of rising diagnoses. However, it did not reduce late-stage presentations or eliminate socioeconomic differences in stage at presentation. These findings suggest that centralisation of diagnostic services alone is insufficient in achieving equity in PCa detection.