Elderly African American men are less likely to get tested for prostate cancer

Elderly African American men are less likely to get tested for prostate cancer than elderly white men, according to an article in the September 27 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, major racial differences exist in prostate cancer incidence and death rates in the United States. African American men are 60 percent more likely to be diagnosed with prostate cancer than white men and twice as likely to die from it, the article states. Low screening rates among African American men may contribute to these disparities, but few data exists on racial differences in prostate cancer screening.

Timothy Gilligan, M.D., of the Dana-Farber Cancer Institute, Boston, and colleagues studied differences in prostate cancer screening rates using the prostate-specific antigen test (PSA test, a blood test) among African Americans and white men aged 65 years and older who participated in the Medicare and/or Medicaid program in New Jersey.

The researchers looked at the medical records of 33,463 men who underwent routine prostate cancer screening between January 1, 1994 and December 31, 1996. These men were matched to 33,782 control patients of the same age who did not undergo prostate cancer screening. Among the patients studied, 5.7 percent were black and 87.6 percent were white.

The researchers found that black men were only half as likely to be tested for prostate cancer as white men. Men classified as living in poverty or near poverty were 67 percent and 31 percent less likely to undergo prostate cancer screening, respectively.

"Elderly blacks are substantially less likely to undergo PSA screening than elderly whites," the authors write. "Differences in socioeconomic status and comorbid conditions explain only a small part of the racial differences in screening rates.

In an accompanying editorial, M. Suzanne Stratton, Ph.D., of the Arizona Cancer Center, Tuscon, Arizona, and Isis Calsoyas, B.S., write, "In this issue of ARCHIVES, Gilligan et al examine rates of prostate cancer screening in African American men compared with men of other races in the United States. Data adjusted for socioeconomic status and comorbidities in this report show that African American men are less likely to undergo routine screening for prostate cancer as recommended by the American Cancer Society which suggests that greater efforts must be made to advocate screening in this population to reduce prostate cancer mortality."

The editorialists state that "Although these statistics indicate a positive race association in the high incidence of prostate cancer, race is still a debatable indicator of cancer incidence. Numerous reports have examined variations in dietary factors and biological factors, including genetic susceptibility and testosterone levels, however, findings have thus far been inconclusive."

"Gilligan et al highlighted that this analysis was not a study directed at determining the causality of the higher incidence of prostate cancer and lower rates of PSA screening in African American men," they write. "Therefore, as discussed in their report and reports by other investigators, more aggressive measures are needed to evaluate the causality of race association in PSA screening, cancer onset, and mortality rates."