Friday, October 16, 2009

Prostate Cancer Discrimination

Today’s post seems to leave me and will leave you, with more questions than answers, but at the least it will raise your awareness and perhaps encourage you to seek answers.

I am reviewing some mini grant proposals at my day job. We fund local programs that use community health workers to take messages of health promotion and disease prevention to the medically underserved. Today I reviewed one about prostate cancer. It was a great proposal, and in the rationale for the program the grant seeker noted that there was a disparity in prostate cancer risk and mortality for black men.

While at work I looked up the statistic and found that MORE than double the rate of blacks then whites had the cancer. I could not find that same statistic these evening, I am not sure why. (but just now I did find this link from the CDC and it shows the great disparity)

I was intrigued by the information I found tonight as well. As all the research I have reported here to date has been involving the controversy of the PSA test. What I keep reading is that the test’s value is questionable because most men die of other causes before that cancer can progress and kill them. Few cases are aggressive and debilitating and the screening may find them early and save lives, but often the screens find benign growths and the treatment is more disabling than the disease. That is what I always read.

To find the information about black men, and this is world wide not just black men in the USA, you have to look specifically for it. It shouldn’t be that way.

Here is what I found from the American Cancer Society. Both blacks and whites and males and females die most from lung cancer which is responsible for about 30% of all cancers. Next for men of both races is prostate cancer and for both races of women it is breast. Here the disparity shows, 9% for white men and 12% for black. For women and breast cancer it is 15 for whites and 19 for blacks. (but this is later data then above, so maybe the gap has closed a bit)

I found several research articles and the hypothesis is that there may be some hormonal difference that triggers a gene expression or more aggressive form of both the prostate and breast cancer diseases. Black men are being screened and black men have heard the message that they are at greater risk than whites.

I guess my biggest question was why they die of a cancer that is not supposed to be that aggressive and after reviewing the research I think I am not the only one that doesn’t know the answer. If however, the cancer is more aggressive and PSA tests will find it and black men will improve their outcomes from treatment, then in them it may be a more valid test.

BTW, the ACS has some 2009 data projections on its website and lung cancer cases incidence (new cases) is actually going DOWN, it is being displaced in the top seat by the two cancers mentioned today while colon cancer, another killer of both sexes and races, is third. We can thank the tobacco control experts for that lung cancer decline. It takes 20 or more years for lung cancer rates to rise in countries after cigarettes are introduced. We had a nationwide smoking rate of about 42% in 1964 and it is down to 19% nationwide today. No matter the cancer, being a tobacco user will increase a persons risk of getting and dying from it.

here is the overall chart for both races from the ACS

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