Racial disparities in Black men with prostate cancer
The incidence of prostate cancer is continually increasing. Black men are disproportionately affected by prostate cancer; they have the highest prostate cancer incidence in the United States with earlier presentation, more aggressive disease, and higher mortality rates versus White men. Many black men have less access to prostate cancer treatment and experience longer delays between diagnosis and treatment. Racial disparities observed among Black men with prostate cancer are multi-faceted. The history of segregation and mistreatment in the health care system may contribute to mistrust among Black men. Cultural factors include generalized mistrust of the health care system, poor physician-patient communication, lack of information about prostate cancer and treatment options, fear of prostate cancer diagnosis, and perceived societal stigma of the disease. In the United States, geographic trends in racial disparities have been observed. Economic factors, e.g., cost of care, recovery time and cancer debt, play an important role in racial disparities observed in prostate cancer treatment and outcomes. Racial diversity is often lacking in genomic and precision medicine studies. Black men are largely underrepresented in key phase 3 prostate cancer trials and may be less willing to enroll in clinical trials due to lack of awareness, lack of diversity in clinical trial research teams, and bias of health care providers to recommend clinical research.
The recommendation by the American Cancer Society to discuss screening for prostate cancer at an earlier age in Black men (starting at age 45 years) could help increase the chances of an earlier diagnosis. However, interventions to address the differences between cancer treatment and survivorship are still needed to help decrease disparities associated with prostate cancer. Solutions to address these factors include educating clinicians and institutions on barriers Black men experience, increasing the diversity of health care providers and clinical research teams, and empowering Black men to be involved in their treatment.
Cancer. 2022, Sept 6;https://doi.org/10.1002/cncr.34433