Poorer Health Care Ups Black Men's Prostate Cancer Risk

By Alan Mozes
HealthDay Reporter
Monday, March 12, 2007; 12:00 AM

MONDAY, March 12 (HealthDay News) -- Black American men are at a higher risk for developing prostate cancer and dying from their illness, because they often lack access to routine health care, a new study suggests.

While black men face a greater than 60 percent higher risk for prostate cancer than whites, prior efforts to explain that disparity have focused on a mix of genetic predisposition, poor education, and a general distrust of the medical system among the black community.

But the new findings, to be published in the April 15 issue ofCancer, reveal that black American men are, in fact, well-educated when it comes to prostate cancer risk.

Instead, the authors find that, compared with white Americans, black men too often lack health insurance or a regular relationship with a primary care doctor. In those cases, the diagnosis and treatment of prostate trouble falls behind.

According to the study's lead author, the findings counter what he called the "blame-the-victim, paternalistic take on African-Americans and prostate cancer".

"To explain worse outcomes among African-Americans, there's been this idea that 'these uneducated people don't get it,' " said Dr. James A. Talcott, director of the Center for Outcomes Research at Massachusetts General Hospital Cancer Center and a professor at Harvard Medical School in Boston. "That they just have wacky beliefs about treatment and doctors, and don't appreciate the risks. And, if anything, it is the opposite. It isn't about cultural beliefs, and it isn't that they're uneducated or uninformed. It is that many are poor, lack insurance, and have lousy access to health care."

According to the Prostate Cancer Foundation, prostate cancer affects one in six American men, making it the nation's most common non-skin cancer.

Overall risk rises with age, with more than 65 percent of all cases occurring among men 65 and older. Black Americans, in particular, are almost 2.5 times more likely to die of the disease than whites.

Talcott teamed up with colleagues at the University of North Carolina at Chapel Hill School of Medicine to survey 84 black American men and 253 white men from North Carolina, all of who had been diagnosed with localized prostate cancer between 2001 and 2004. Patients were between the ages of 40 and 75.

Questions centered on prostate cancer screening history, family history, access to care, general attitudes toward health and health care providers, physician relationships, treatment experience, co-existing disease, and symptoms.

While 55 percent of blacks earned below $40,000, just 23 percent of the white men fell into that income bracket. Black participants were also more likely to have blue-collar jobs, lower educational backgrounds, co-existing disease, and to be jobless as a result of illness or disability.

Survey results indicated that black men fared much poorer in terms of health insurance. While only three percent of whites lacked insurance altogether and almost one-third had some private Medicare supplementary coverage, eight percent of black men lacked any coverage and just 17 percent carried a Medicare supplement.

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