Sounding Alarm About Disease
In Charles County, Where Men Are Dying From Prostate Cancer At Startling Rates, a Campaign Aims to Educate Those At Risk

By Lisa Rein
Washington Post Staff Writer
Sunday, July 27, 2008

The preacher's words took flight in a small Pentecostal sanctuary in Southern Maryland, where men are dying needlessly of a treatable disease.

"Your body is special to God!" Bishop James M. Briscoe declaimed to 45 Sunday worshipers in the pews above the weathered linoleum floor of Free Gospel Church of Bryans Road. "God has not designed this thing for you to die prematurely! Some of you would rather not go to doctors. They would rather be in the darkness about their health. But the scripture doesn't say that."

So began a public health campaign to educate, examine and treat the men of Charles County as prostate cancer becomes a disease that is striking and killing them at an alarming rate.

Men, black and white, in Southern Maryland's largest county have the highest prostate cancer diagnosis and death rates in the state, and significantly above the national average. Local rates are climbing even as cases level off nationwide.

According to the most recent National Cancer Institute statistics, 254.7 black men per 100,000 people in Charles had a diagnosis of prostate cancer between 1998 and 2002. That compares with 226.8 in Maryland and 248.5 nationwide. More recent statistics put the rate for black men in the District at 235.6. White men also had elevated rates, with an even wider gap between local and national numbers: 174.1 per 100,000 in Charles compared with 157.4 in Maryland and 156.7 nationally.

"Like so much else about the disease here, that is a mystery," said C. Devadason, the county's health director.

The disease's prevalence in Charles over a decade has confounded epidemiologists, although they have some theories. The once-rural farming community is quickly becoming a suburb of subdivisions and strip malls, but the boom has left behind neglected neighborhoods where people have no health insurance. Many prostate cancers are slow-growing compared with other cancers and might not be life-threatening. But like many diseases, prostate cancer can go undiagnosed longer in men with poor health care, slimming their chances for survival.

And it strikes African Americans at 1 1/2 -times the rate as whites. Blacks make up a third of the county's population, one of the nation's fastest-growing black communities.

Although the U.S. death rate for prostate cancer was 38.5 per 100,000 in 2004, the last year for which statistics are available, in Charles it was 49.6. And there the disease killed at a rate 80 percent higher for blacks than whites. The District's mortality rate was 46.5.

Community and health experts have many theories for the high incidence in Charles: the tobacco use that drove the Southern Maryland economy for so many years; the jobs making gunpowder at the Navy base in Indian Head, which now makes high-tech explosives; the poverty of the isolated peninsula known as Nanjemoy.

Finding the right answer is likely to take years of costly, painstaking research. But a group of health officials, local activists and a tenacious state lawmaker have set their sights on what they say is a more urgent mission: educating thousands of men about the disease and screening and treating for free hundreds of low-income men, who are most at risk.

Experts are hailing the $280,000 program that began last month -- a shoestring budget by the standards of bigger public health studies -- as a potential model for low-income communities. Instead of scientists in faraway labs, the community is leading the way. Although the pilot program treats white and African American men, it is the black community that pushed for and has embraced the project.

The journey begins in the pews of the county's black churches, where a few Sundays ago, Briscoe told his congregation that the long-awaited prostate cancer money had arrived. "It's for the underinsured and the no-insured!" he said before announcing that he had been tested to set an example.

"So many men are dying," said Dolores Datcher, a local health educator whose brother and late father were affected. "The community is finally coming together."

The illness is striking men such as the Rev. George DeFord, who went for a screening at Datcher's urging two years ago and learned that his prostate gland had a tumor, but, after successful surgery, he takes comfort that he is healthy enough to indulge his newfound passion for swimming. And Gerard Myers, a retired postal service manager, got the diagnosis 15 months ago after surviving bladder cancer in the late 1980s.

Some of these men have health insurance. Others do not or fall into a group of millions of Americans designated by health experts as the "underinsured."

"I had insurance at one point," said Don Sandidge, a self-employed contractor who beat testicular cancer but lost an uncle to prostate cancer. During chemotherapy for testicular cancer, he was unable to work and could not afford the $200 monthly insurance premium. He has not taken the prostate screening.

As his friend Mark Douglass, a deacon at Free Gospel put it, "It's not a fun test," referring to the rectal exam that goes with the blood test to screen for the disease. But after his screening a few months ago, Douglass told the guys at work they should get checked. One who took his advice discovered cancer.

Datcher started to reach out to men in her county three years ago, with a small grant from the University of Maryland. "I would come to a church with a roomful of men who would tell me, 'I have no insurance. I can't get treatment,' " she recalled. The cost of a screening by a private doctor varies, but Medicare provides a $45 reimbursement for the tests and $60 for an office visit.

Datcher enlisted the Ministers Alliance of Charles County and Vicinity, local health officials and Claudia Baquet, a doctor and specialist in health disparities at the University of Maryland School of Medicine, to approach Thomas M. Middleton (D), the county's longtime state senator. The community's dramatic testimony at hearing last year helped persuade the General Assembly to set up an 18-month program for screening and treatment.

But the Prostate Cancer Pilot Program had no funding. Middleton was back before the legislature this year, having persuaded state health officials to contribute $82,000 from Maryland's tobacco restitution fund. More money came from the county and from Baquet, who is using a research grant from the National Cancer Institute.

Health officials hope to reach 2,000 men at health fairs, ethnic festivals, barbershops and, of course, churches, screening perhaps 200. A converted schoolhouse in Waldorf will serve as the health clinic, to create a more personal setting than a hospital.

In Waldorf, Wayne Barnes, 58, is starting the county's first support group for survivors. He got his diagnosis in January and chose a radical prostatectomy over radiation or "watchful waiting," a wait-and-see course often recommended for elderly men whose cancer is slow-moving. With a brother and father who also are survivors, Barnes had faithfully been screened and considered himself particularly fit. "I never smoked a day and rarely drank," the Defense Department consultant recalled. He now proselytizes his black brothers, using his leadership of his local alumni chapter of Morgan State University as a bully pulpit.

The American Cancer Society estimates that prostate cancer will be diagnosed in 186,320 men in the United States this year, 3,420 of them in Maryland. The disease is the fifth leading cause of death among men older than 45, although many more have the disease but do not die from it. Early detection has dramatically improved five-year survival rates, although they are still worse for black men.

Older age is a big risk factor. Genetics and environment are believed to play roles, too. A poor diet and high tobacco or alcohol use are considered risks, as is family history. Men with fathers, brothers or sons with the disease are more than twice as likely to develop it.

Through the pilot program, screenings will be offered free to Charles men who are at least 50 with either no insurance or high deductibles on their policy. The eligible age drops to 40 for those who are at high risk for the disease.

The blood test measures the amount of a protein produced in the prostate gland and typically is done regularly to measure changes over time. An elevated level can have a number of causes and does not necessarily mean cancer; a biopsy is required to confirm that.

Those offered treatment could have surgery to remove their prostate gland or radiation or take the watchful waiting course.

Unlike mammograms, which have been shown to reduce death rates from breast cancer, the effectiveness of prostate tests is debated by cancer specialists. But for now it is what's available.

The nagging question for health researchers is why the county's cancer rate exceeds that of Prince George's or Baltimore, communities with far larger black populations. Prostate cancer struck African American men in Prince George's at a rate of 201.6 per 100,000 people in 2002.

"In the long term, we want to know the root of the disparities," Baquet said. "In the short term, we're seeing a population that's saying, 'I did not go in for screening because I didn't have insurance' or 'I was afraid.' While you're waiting for all the answers, you can't just do nothing."