Black men in the United States are significantly less likely to be screened for prostate cancer

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Although black men in the United States are more likely than white men to be diagnosed with advanced prostate cancer and have a two-fold greater risk of dying from it, they are significantly less likely to be screened for prostate cancer, according to a Dana-Farber Cancer Institute and Brigham and Women’s Hospital study.

In a study involving more than 67,000 men age 65 years and older, the researchers found that blacks were 35 percent less likely than whites to undergo prostate-specific antigen (PSA) testing. The findings will be published in the Sept. 27 issue of the Archives of Internal Medicine.

“The level of racial disparity in the use of PSA screening is quite unsettling,” says Timothy Gilligan, MD, a genitourinary oncologist at Dana-Farber and the paper’s lead author. “While some physicians question the effectiveness of PSA as a screening test, there is no reason its availability should differ according to a man’s race. Indeed, because blacks are at higher risk of dying from prostate cancer, they stand to benefit the most from screening.”

Prostate cancer is the second leading cause of cancer death in men in the United States. The American Cancer Society estimates that nearly 30,000 men will die from the disease this year and that 230,000 cases of prostate cancer will be diagnosed. While the prostate cancer mortality rate for blacks has declined a little during the past decade, it is still more than double the rate for other races and ethnicities. Prostate cancer also tends to be detected in blacks at a younger age and at a more advanced stage than in whites.

The researchers’ findings were derived from claims 67,245 New Jersey residents filed with Medicare, Medicaid and the New Jersey Pharmaceutical Assistance to the Aged and Disabled program from 1991 through 1996. Men who were previously diagnosed with prostate cancer were excluded from the study. To overcome the limitations of previous studies that looked at racial disparities, the researchers accounted for differences in age, socioeconomic status, use of health care services, and presence of other diseases and medical conditions – factors that are known to impact the use of primary and preventive care services.

While the study established there is a racial disparity in prostate cancer screening use, it did not identify its causes or its impact. The researchers note that potential contributing factors could include racial differences in access to care and education levels, patient preferences, and care provider recommendations.

Gilligan says the racial disparity they identified in prostate cancer screening is illustrative of a greater problem in the current health care system. “In terms of providing primary care and preventive services, the medical community has come up short in the minority communities.”

Jerry Avorn, MD, of Brigham and Women’s, is the paper’s senior author. Philip Kantoff, MD, of Dana-Farber and Philip Wang, MD, DrPH, and Raisa Levin of Brigham and Women’s are co-authors.

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