For several years, the “Your Health Matters” section of The St. Louis American has been dedicated to providing relevant and factual medical information with the singular goal of eliminating health and healthcare disparities. It is our desire to share the latest research, introduce the public to the clinicians and scientists at the forefront of the most recent medical advances, and direct consumers to needed services within the community. We here at The St. Louis American also believe that our mission is to encourage advocacy when apparent negligence exists as it relates to the well-being of minority and poverty-stricken individuals.
Often times we, along with our trusted partners, initially forge a lonely path as we set out to bring attention to hot topic issues, such as prostate cancer screening. That is the current situation as we try to bring clarity to the confusion surrounding screening and PSA testing. We hope to shed light on the recommendations and provide the necessary tools to help empower men to make the right decisions regarding their care.
After the USPSTF, United States Preventive Services Task Force, advised against prostate cancer screening with PSA, the number of men being screened dropped exponentially, including those men who would be considered high risk. The studies used by the task force to compile their guidelines did not have significant numbers of African American men, who by most standards have the most lethal cases of the disease.
Black men are 60 percent more likely to be diagnosed with prostate cancer, more likely to have a higher tumor grade upon diagnosis, and they are more likely to be diagnosed at a younger age. It is for those reasons alone there has been such an outcry against the USPSTF recommendations, particularly amongst individuals who care for African American men. Additionally, there have been some genes identified in black men that increase their risk, but this gene is absent in the majority of black men with prostate cancer. Definitely, more research is needed in this area.
Socioeconomic factors also play a huge part in prostate cancer disparity. Black men are more likely to be uninsured or underinsured which then results in delays in screenings and treatment. It has been shown that black patients often are not aware of the multitude of options available to them in regards to cancer care. Education is another component that contributes a crucial dynamic within the outcomes paradigm of prostate cancer for black men.
Education is not just an issue for the patient, but also for primary care providers. As an educator of future doctors, I am very aware that students and residents (doctors in training) are being taught not to test at all. That behavioral practice is also being mirrored to them by their preceptors. So what will that mean for black male patients five to10 years down the road? My prediction, along with other concerned providers is that the number of black men dying from prostate cancer will dramatically increase.
Although the PSA test is an imperfect test at best, it is what we have currently. Scientists are working on other ways to diagnose prostate cancer and determine risk, though. Since 1994, PSA has been used as a screening test and elevated levels can be indicative of prostate cancer but also BPH, benign prostatic hypertrophy. Therefore, just because the PSA level is elevated, the patient does not automatically proceed to radical prostatectomy.
So what are the next steps of intervention to prevent this potential rise in prostate cancer-related deaths of African American men? Because of the insight of a local radiation oncologist Dr. Lannis Hall, a Prostate Cancer Coalition was formed to educate the community – patients, health centers, academic institutions and community primary care providers. Approximately 70 physicians have joined Dr. Hall by signing a petition regarding smart screening. Other local partners such as The Empowerment Network are also involved.
I personally encourage all men to discuss this issue of screening with their doctors and read the recommendations from the American Cancer Society. We cannot sit idly by and wait until a catastrophe happens. The time for action is now.
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
