Black males are far more likely than their white peers to die from prostate cancer, an outcome that is tied to the stage at which the disease is diagnosed, according to a new study conducted by researchers at the Yale School of Public Health.
The racial disparity in stage at diagnosis is largely due to socioeconomic factors and access to health care—not necessarily biological differences—and is therefore potentially reversible, said Beth Jones, an associate professor and the study’s lead author.
Prostate cancer is a major health threat to adult men, with some 186,320 new cases expected to be diagnosed in the United States this year. The Yale researchers examined data from 251 Connecticut men with the disease and found African–American males were more than twice as likely to be diagnosed at a more advanced stage and had a far greater chance of dying from the disease. Prostate cancer fatalities are closely linked to the stage at which the disease is diagnosed. When detected early, there is a nearly 100 percent survival rate.
Researchers found that there was not a single reason for the diagnostic delay among African–American participants; but rather a complex blend of factors likely accounted for the difference. Blacks were generally of lower socio–economic status, had less access to health care and were less likely to have a regular doctor or to have visited a doctor in the year before diagnosis. They also were less informed about medical insurance coverage and had more problems arranging transportation to a doctor’s office. There was not a significant difference in lifestyle between the races (e.g., smoking, alcohol consumption and body mass index).
However, it was the race difference in socioeconomic status, prior experience with prostate cancer screening, and a poor understanding of insurance coverage that explained most of the disadvantage in terms of the cancer’s stage at diagnosis. Interestingly, these same factors also contributed to poorer survival for African– American men, even after accounting for their later stage and more aggressive tumors.
Jones said that identifying barriers to prostate cancer screening is necessary in order to develop strategies to reduce or eliminate the existing racial differences in diagnosis and survival.
“The good news is that there is now greater awareness of the higher risk of prostate cancer among African–American men—and there is greater acceptance and availability of prostate screening—and with early detection, the race differences in cancer outcomes are greatly diminished,“ Jones said.
Details of the research were published in the October issue of the journal Cancer Epidemiology Biomarkers & Prevention. Other Yale School of Public Health researchers involved in the study include Stanislav V. Kasl, Robert Dubrow, and Mary G.M. Curnen. Researchers from the China University of Technology, New England Research Institutes, Montclair State University and University of Miami Miller School of Medicine also participated.