Low income men diagnosed more often with advanced prostate cancer

Coincident with the widespread adoption of PSA screening, the proportion of American men diagnosed with organ-confined, low risk prostate cancer has increased significantly during the last two decades. In a study scheduled for publication in the February 2009 issue of The Journal of Urology, researchers report that for low-income men, the opposite is true, with more men undiagnosed until their cancers had reached more advanced stages.

Examining the records of 570 disadvantaged men from the California IMPACT (Improving Access, Counseling and Treatment for Californians with Prostate Cancer) program designed to provide high-quality care for prostate cancer patients, the authors from the University of Michigan, University of California, Los Angeles, UCLA's Jonsson Comprehensive Cancer Center and the Veterans Administration, Greater Los Angeles Healthcare System, found that 19% of these men had metastatic cancer at diagnosis, in contrast to approximately 4% of men from the general population tracked in other studies. Further, the diagnosis rate for low-risk, less advanced cancers in the IMPACT patients did not increase, also in contrast with a significant rise in these diagnoses in the more affluent population.

The proportion of men in the program presenting with metastatic cancer did not change over time, indicating that low-income men were not receiving prostate cancer screening services that have been shown to reduce the diagnosis of late-stage cancers in the general population.

Writing in the article, David C. Miller states, "Our principal findings clarify some of the challenges (and opportunities) faced by public assistance programs designed to reduce cancer related disparities. Without question IMPACT enables eligible men to receive previously unattainable-and high quality-prostate cancer care…However, from a population perspective the persistent preponderance of metastatic and higher risk localized cancers suggests that more comprehensive strategies are needed to eradicate socioeconomic disparities in prostate cancer specific morbidity and mortality. …" while much attention now focuses on potential overdiagnosis and overtreatment of men with screen detected prostate cancer, our findings serve as a reminder that for disadvantaged men underdetection and undertreatment of prostate cancer remain significant concerns."

In an accompanying editorial, M. Norman Oliver of the University of Virginia School of Medicine comments that men from minority groups who live in poverty and are diagnosed with prostate cancer are more likely to die of their disease than those men with a higher socioeconomic status. He writes, "However, we must address more than socioeconomic disparities in prostate cancer care…African-Americans have a disproportionately high rate of poverty with some 25% living below the federal poverty level compared to 8% of the white population in that category. This racial disparity in combination with the socioeconomic disparity already discussed places African- American men diagnosed with prostate cancer at an even greater risk of presenting with incurable disease."

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