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The largest genetic study of prostate cancer pooled 107,247 men with the disease and 127,006 without, across ancestries. It brought the number of known risk variants to 269 and showed that men of African ancestry carry, on average, more than twice the genetic risk score of men of European ancestry.
David Conti, Christopher Haiman, Rosalind Eeles and a very large consortium ran a multi-ancestry meta-analysis of prostate cancer genome-wide association studies and combined the resulting variants into a genetic risk score, then compared the distribution of that score across ancestry groups.
The finding that matters for policy is the last one. Prostate cancer incidence and mortality differ sharply by ancestry, and the argument about why has run for decades between biology and access to care. This paper supplies a measured component of the biological side: the mean genetic risk score is 2.18 times higher in men of African ancestry and 0.73 times that of European ancestry in men of East Asian ancestry. It does not settle the mortality question, which Dess and colleagues addressed by adjusting for access, but it does say that a screening programme whose entry criterion is age alone is using the wrong variable.
The evidence base for setting the age at which screening starts by risk rather than by birthday. It is also a warning: the same score performs differently across ancestries, so a risk model built and validated in European cohorts will under-serve the men at highest risk.
Shares Association of Black race with prostate cancer-specific and other-cause mortality, Other-cause mortality, Report death from other causes as an outcome of the prostate cancer service, split by deprivation and ethnicity, Screening and the tag prostate-evidence.
Shares MRI-first prostate screening with genetic pre-selection, Use a polygenic risk score to set when screening starts, Screening, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch and the tag prostate-evidence.
Shares Other-cause mortality, Report death from other causes as an outcome of the prostate cancer service, split by deprivation and ethnicity, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, Prostate cancer and the tag prostate-evidence.
Shares Screening, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, The hardest cancers are found late, Prostate cancer and the tag prostate-evidence.
Shares Screening, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, The hardest cancers are found late, Prostate cancer and the tag prostate-evidence.
Shares Nature Genetics, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, Prostate cancer and the tag prostate-evidence.
Shares Screening, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, The hardest cancers are found late, Prostate cancer and the tag prostate-evidence.
Shares Screening, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, The hardest cancers are found late, Prostate cancer and the tag prostate-evidence.