Being a Black Man: Health Care Education and Awareness

Among the 10 leading causes of cancer death in African American men, prostate cancer is second, behind lung cancer. When compared to all causes of death, prostate cancer is the fourth leading cause of death among African American men over age 45, according to the Centers for Disease Control and Prevention (pdf).

Thomas Farrington is president and founder of the Prostate Health Education Network (PHEN), a Boston-based nonprofit organization focusing on the urgent and unmet prostate education and awareness needs of African-American men. Farrington, a five-year prostate cancer survivor, convenes the "African American Prostate Cancer Disparity Summit" on Capitol Hill each year. He is also the author of "Battling the Killer Within," and "Battling the Killer Within and Winning."

Farrington was online Fri., Oct. 6 at 11 a.m. ET to discuss his battle with prostate cancer, the high incidence of the disease in the black male community, and his movement to get black men to visit a doctor and get tested for this and other diseases.

Post reporter Darryl Fears's chronicle of the last months of a local activist's battle with cancer is the latest installment of the " Being a Black Man " series.

The transcript follows.

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Thomas Farrington: Black men in the United States suffer the worlds worst prostate cancer conditions. With an incidence rate 60% higher and mortality rate 140% higher than all other men of any racial and ethnic group, prostate cancer has the highest racial disparity for any type of major cancer.

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Helena, Mont.: To my knowledge, on average women live longer than men because men are exposed to more risks, women visit the doctor more often, even unnecessarily, and women's diseases -- like breast cancer -- garner more funding and media attention. That said, are black men likelier to die of prostate cancer than nonblack men because black men visit the doctor less often so the disease is detected less often in blacks, because black men have worse health habits (e.g., diet, exercise), because black men are poorer (e.g., lack of a spouse's income or health insurance coverage), because black men are more fearful of doctors for cultural or historical reasons (e.g., Tuskeegee, homophobia), because black men have a genetic predisposition to get prostate cancer more often, or a combination of some or all of the foregoing factors? I read in Men's Health that regular sex and proper diet all but eliminates the risks of prostate cancer unless it is hereditary -- I wonder if that is true.

Thomas Farrington: At our just completed summit on Capitol Hill we conducted a session titled; "Why The African American Prostate Cancer Disparity?" This session was quite revealing in identifying a number of factors contributing to the disparity. The bottom line is that while all the factors you cite come into play, our medical care system is not as responsive as need be to Black men's prostate health care. Visit our website at www.prostatehealthed.org for more information on this subject.

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Mattapan, Mass.: Can you provide any suggestions on ways to encourage black men to get regular visits. I believe that fear is what keeps alot of men out of the Dr.'s office~ as an outreach specialist, how can I convince the Black men in my community to get screened?

Thomas Farrington: Getting men to go to the doctor is a challenge. For prostate health I always let men know that prostate health is important for sexual health. Most men do not understand the connection. Treatment side effects for prostate cancer can include sexual dysfunction. However, early detection of prostate cancer means that your chances of sexual dysfunction can be dramatically reduced.

On our website; www.prostatehealthed.org visit "Dr PSA". We have created this character to help men better understand managing their prostate health.

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Thomas Farrington: Tom, I have been supporting your prostate cancer initiative from its inception. How are you doing with your message for men in the church?

Thanks for your outstanding support! PHEN works with churches on an on - going basis. At local levels some churches are actively supportive, however more can and needs to be done with churches. National church leaderships could make a tremendous impact by taking this issue on as a priority. We also use awareness posters that are posted in barbershops and other community establishments that helps with awareness

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Washington, D.C.: Mr. Farrington,

I was able to attend part of your summit on the Hill, and in the hour I was there, I was most shocked to find that the disparities between white and black men in treatment were often between men who had the SAME access-- they were insured and visiting the doctor, sometimes the same doctor, but getting different care. What do you think accounts for this difference, and how can doctors, nurses, PAs and others do to communicate better with their patients?

Thomas Farrington: Unquestionably there are disparities in health care that impact on the high death rates of Black men from prostate cancer. Because of our higher risk level and tendency to get prostate cancer at an earlier age we need better attention and care. Worst care is a double whammy for us. Better education and awareness at all levels are required to combat this situation. We must be knowledgeable advocates for our prostate health care.

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Smyrna, Ga.: What are the early symptoms and is going to the doctor the only way of detection?

Thomas Farrington: Unfortunately there are no early symptoms of prostate cancer. A PSA blood test and eigital rectal exam are the only procedures used today for early detection. These exams are performed by your primary care doctor. According to guidelines Black men should begin screenings by age 45. If you have a family history of prostate cancer screening should begin at age 40.

of prostate cancer can include frequent urination, blood in the urine and others. However, all these symptoms usually occur after prostate cancer has been present for some time.

Thomas Farrington: Unfortunately there are no early symptoms of prostate cancer. A PSA blood test and digital rectal exam are the only procedures used today for early detection. These exams are performed by your primary care doctor. According to guidelines Black men should begin screenings by age 45. If you have a family history of prostate cancer screening should begin at age 40.

of prostate cancer can include frequent urination, blood in the urnine and others. However, all these symptons usually occur after prostate cancer has been present for some time.

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Anonymous: Is it possible to have an accurate self examination of prostrate as you can possibly do in testicular cancer?

Thomas Farrington: No!! You must visit your doctor for screening using the PSA test and digital rectal exam.

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Washington, D.C.: If you have prostrate cancer and have had surgery and are doing well, will it come back, is there a strong reason to believe that it will return, within those 5 years?

Thomas Farrington: There is always a risk for the recurrence of prostate cancer regardless of the type of treatment. With surgery recurrence is usually caused by microscopic cancer cells that escaped prior to surgery. This is the reason that it is important to have continuous PSA tests after treatment. I am a six year survivor and I get a PSA test every six months.

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Washington, D.C.: These high rates of mortality for our people, isn't it a subtle form of ethnic cleansing?

Thomas Farrington: If we ignore these conditions this is a very effective and quiet way for Black men to leave this earth. We must become advocates! PHEN has been effective in getting our US congressional members to become actively involved. This has to be done at every level. This is a political as well as health crisis.

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Washington, D.C.: I am 40 years old. What age should I get tested for prostate cancer?

Thomas Farrington: You should meet with your doctor and begin screening test now!

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Washington, D.C: I will like to know the early symptoms of prostate cancer. Also,as a black man over 40 years, how do I get my HMO (Kaiser Permanente) to check for these symptoms when I do my annual physical. There is usually no indication that they do. Thanks

Thomas Farrington: You should request that your HMO specifically screen for prostate cancer using both the PSA blood test and the digital rectal exam. After each screening obtain you records and use them for a face to face discussion with your doctor. All Black men are at high risk for prostate cancer and comparison of the results are important in understanding whether your PSA is stable or increasing. If it is increasing the doctor should be able to determine when it becomes cause for further testing.

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Boston, Mass.: Please address how the family can help in this battle against prostate cancer.

Thomas Farrington: It is very important for the wife, children and other loved ones to understand the prostate health care needs of the men in their lives and help encourage them to get screened. My wife was very instrumental in pushing me to get screened. If there is a cancer diagnosis men will need the emotional support of their family and friends.

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Washington, D.C.: Hi and thanks for doing this chat. I've seen so many studies showing the link between a bad diet and prostate cancer-yet when I go to black neighborhoods I see stores/restaurants with so few-if any-fresh produce.

Mostly I see fast food places and very few places that offer the foods we know reduce the risk of p.c., diabetes, hypertension, stroke, etc. What can we do? I know it isn't a conspiracy but can anything be done? Surely some of the risk of p.c. can be attributed to genetic issues, but how much is based on poverty and the decisions the impoverished are faced with w/respect to food?

I know it isn't some goofy conspiracy but is there anything that can be done to tip the scales in those communities to foster healthier eating?

Thomas Farrington: I have read many reports and seen a number of presentations linking prostate cancer to diet. When I was in treatment, my treatment center had regular sessions on nutrition that emphasized a proper diet for survivors. Prostate cancer survivors are at risk for a cancer recurrence and proper eating habits were emphasized. Diets high in fat content an charred barbequed meats were especially considered risky. You can see that these are considered staples in our communities.

I believe that an awareness of proper and less risky eating habits need to be emphasized much stronger for overall health.

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Washington, D.C.: What do the doctor's do to check you for Prostate cancer?

Thomas Farrington: Screening is done using a PSA blood test and a digital rectal exam. Further testing is carried out using a biopsy.

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East Brunswick, N.J.: According to Dr. David M. Satcher, if the disparity in health were eliminated in the last century,there would have 85,000 fewer black deaths overall in 2000. How many fewer black men would have died from prostate cancer in 2000, assuming the disparity was in fact eliminated?

Thomas Farrington: Black men die at a rate 2.4 times that of other men in our country. By eliminating the disparity the deaths would be divided by 2.4. I do not know the exact deaths in 2000, but we would have saved an estimated 2000 lives.

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Daytona Beach, Fla.: Tom: I was told by a physician that I did not need radiation for my enlarged prostate cancer. Explain.

Thomas Farrington: Clearly I am not aware of your specific conditions. An enlarged prostate that is not cancerous is not treated with radiation. If you had an enlarged prostate that was treated and later found to be cancerous the doctor may decide for numerous reasons that radiation is not advised.

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Boston, Mass.: Mr. Farrington, what are the chances of prostate cancer occurring in the offsprings of the cancer patient?

Thomas Farrington: A Family history of prostate cancer increases the risk for being diagnosed. Offspring are at a higher risk level for the disease.

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Arlington, Va.: I am just turning 30 years old. There is a history of breast cancer and colon cancer in my family, but no prostate cancer as far as I know. Would now be too early for me to begin screening for prostate cancer?

Thomas Farrington: If there is no history of prostate cancer in your family, most guidelines will recommend that you begin screening at 40 - 45 years of age.

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Baltimore, Md.: Any idea whether Black women take better care of themselves than Black men? I'm a Physician's Assistant for a group of family doctors, most of whom and most of our patients are African American women and children. It's harder than pulling teeth to get many of these women to have mammograms (admittedly painful) and pap smears (much less so), or even to get their children immunized unless it's required for school. Many are also extremely heavy and decline our efforts to have them talk with a nutritionist or consider a weight loss program. And my doctors are affiliated with an HMO and the office sees only members, at absolutely no cost to them, so money is not the issue. It's very sad and frustrating.

Thomas Farrington: Overall it is a well accepted fact that women take better care of themselves medically that men. Many prostate cancer survivors, including myself, attribute their survival to pressure to get a medical from their wife or another woman in their life. Clearly there is room for improvement on both sides.

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Fairfax, Va.: I don't understand, same insurance and same doctor, and different levels of care. What does that mean? I don't see how it can be possible.

Thomas Farrington: Many studies have shown that Blacks receive inferior medical care when compared to whites. This is characterized as "Health care disparity."

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Thomas Farrington: Some studies have shown that selenium and vitamin E in combination reduce the incidence of prostate cancer. There is an on - going large scale clinical trial in the USA to determine the full, if any, effectiveness of these supplements. This is the largest ever prostate cancer prevention trial, known as SELECT. This trial will be conducted over 12 years before we have our answers. Since selenium and vitamin E are available over the counter some men now use them in hopes that they will be effective

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Washington, D.C.: With the costs of health care rising so much, many African Americans have had to let that bill go in an effort to stay afloat. How do we encourage our men to seek health care when we cant cover the costs of a routine exam?

Thomas Farrington: This is a political issue that we must address strongly as advocates. There has been legislation introduced in congress by Congresswoman Maxine Waters (D-CA) and Congressman James Marshall (D-GA) to address these cost issues.

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Washington, D.C.: A friend of mine had prostate cancer and got all the treatment options, he asked what the doctors chose that had the disease, and the majority had their prostates removed. What's your opinion?

Thomas Farrington: There are a range of treatment options available including surgery. Surgery is not the correct option for a number of men based on their age, health or other conditions. Treatment options should be studied closely by all men diagnosed with prostate cancer. Understand the risk and benefits of each option and then decide.

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New Jersey: What kind of approach IS effective in getting a man to a doctor? Appeals to the future don't work, references to family don't work that well. My guess is that consistently portraying doctor visits as fairly routine things that "everybody" does might work.

Thomas Farrington: Different approaches work for different men. This is a challenge that can be overcome through better education and awareness. At PHEN we use prostate cancer survivors as volunteers to help get the message out. I strongly believe that Black prostate cancer survivors are critical in our war to eliminate the disparity. I encourage survivors to join with PHEN across the country. Men can join our campaign by visiting our website www.prostatehealthed.org

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Arlington, Va.: Thank you so much for this discussion! I am a white woman, and my mother died at the age of 59 of colorectal cancer. Her death could have been completely avoided if she had kept up with her annual doctor visits. I know that the focus of this discussion is African American men, but the main point is, regardless of race or gender, your responsibility to your family, your friends and yourself, is to make sure that you are proactive about your healthcare. Thank you again for raising awareness about this issue.

Thomas Farrington: Thank you for this important perspective, that I agree should be a guiding light for us all.

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Thomas Farrington: Prostate cancer is a curable disease with early detection and proper treatment!

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East Brunswick, N.J.: Why do Native American Indians have the lowest incidence rate for prostate cancer, even though their health care system is worse than that of African Americans?

Thomas Farrington: A recent study by the Dana - Farber / Harvard Cancer Institute was published that identified a gene in Black men that they attributed to the higher incidence rate. This study is available at www.prostatehealthed.org

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Arlington, Va.: One issue that has bothered me in general regarding health care is that I simply don't know where to begin. I know I need to see a doctor on a regular basis, but I have no clue what type of doctor to see. I don't know what the doctor should be doing when I get there either. Is there a checklist of things that I should have a doctor do when I go to visit? My last visit to a doctor consisted of this:

1. Weighed me 2. Took my blood pressure 3. Told me to stick out my tongue 4. Checked my heartrate 5. Sent me to the cashier.

Honestly it felt like a total waste of time. I know I need to go, but it's hard to justify going when I have no clue what the doctor should be doing when I get there.

Thomas Farrington: Go to my website; www.prostatehealthed.org, and click on "Dr PSA", this will help you understand how to interface with your doctor about your prostate health.

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Washington, D.C.: This is an addition to my previous comment about my husband and I having no sex in six years. He is a very healthy man. He exercises, works everyday in home building/renovations. He does have high blood pressure, which he keep under control with medicine. We used to try all types of different things, but now he does not want to do anything since he cannot get an erection.

Thomas Farrington: It appears that this is a physical problem caused by the treatment, unless he is currently undergoing hormonal therapy. I suggest meeting with a specialist that can treat this problem.

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