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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.

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

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