Poorer Health Care Ups Black Men's Prostate Cancer Risk

Black men were also twice as likely to seek care at a public clinic or emergency room and less likely to see the same care provider from visit to visit. As well, black patients were three times as likely to say they didn't seek care for a health issue, even when they thought they might need it.

At the same time, black men also reported a greater sense of responsibility for their health and were less likely to trust their doctors. Many expressed the suspicion that doctors based their decisions more on the basis of cost than the patient's health.

With respect to prostate cancer screening, blacks were less likely to have regular check-ups, digital rectal exams, or prostate-specific antigen (PSA) tests. They specifically noted that black men were more than twice as likely to have to request a PSA test (as opposed to being offered one) than whites.

Overall, black patients did not have any more reservations than whites about standard medical treatments for prostate cancer, and their treatment entailed slightly more surgery and slightly less radiation than that of whites.

Based on their data, the researchers believe that black American men are as informed about prostate cancer risk and the need for treatment as whites.

However, other barriers -- such as lack of insurance, weaker established ties to physicians, and poor access to convenient and affordable care -- often prevent them from taking action.

"So, the bottom-line is, you don't have to scare the heck out of African-American men or work hard to convince them that they should seek regular health care," Talcott said. "You don't have to browbeat them. They get it, and they understand the deal. The problem is that many are not getting screened, because they have jobs that don't provide insurance, and because they don't have a regular doctor, and because they simply can't go to an ER for five hours to get looked at."

"So, we have to improve access and trust in the health care system by making sure that these men can build relationships with doctors and access medical care when they need it. That's the answer," he said.

One expert wasn't surprised by the findings.

"We know from past research, such as work in military settings, that where access to prostate cancer care is reasonably equal, outcomes are equal in terms of race," said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society. "Of course, there are other relevant factors that may come into play, including even biologic differences in disease risk and progression. But access to care is the major issue."

"So, it's important that this study shows these men are aware of the risk and aware of the issues," he said. "And it's certainly not that we don't know what to do about it. We've made great progress in research and treatments. But we do not have equal access to health care in this country, and we need to address that. And until we do, we're not going to make the progress we could in terms of the treatment of cancer."

More information

For additional information on prostate cancer, visit the Prostate Cancer Foundation.

SOURCES: James A. Talcott, M.D., director, Center for Outcomes Research, Massachusetts General Hospital Cancer Center, and Harvard Medical School, Boston; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society, Atlanta; April 15, 2007,Cancer