Prostate cancer in black men of African-Caribbean descent

Journal of Cultural Diversity, Summer, 2003 by Jo Ann Kleier

Abstract: Prostate cancer is a significant health problem for middle-aged and elderly men. In the United States (US), it is the most frequently diagnosed cancer and is the second leading cause of cancer death. While men of all racial and ethnic backgrounds are at risk, black men of African descent are at especially high risk. African-Caribbean men, particularly Jamaican men, have the highest rate of prostate cancer in the world. The term African-American has been used to describe all black people living in the US. Use of such broad categorization ignores the existence of subcultures within the black community. While members of the black race may share similar primary, genetic characteristics, skin color cannot be equated with attitudes, knowledge, and behaviors of particular cultural groups. Therefore, prostate cancer interventions developed for African-American men may not be effective for men of African-Caribbean descent.

Key Words: African Caribbean Men, Prostate Cancer

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Background and Significance

Prostate cancer is a significant health problem for middle-aged and elderly men. In the United States (US), it is the most frequently diagnosed cancer, accounting for 36% of all cancer cases (Office of Men's Health Resource Center, 2002) and is the second leading cause of cancer death (Brink, 2000). The incidence of prostate cancer is rare before the age of 55; however, rates increase appreciably with each succeeding decade of life so that up to 75% of all men have cancerous changes by age 75 (Federal Consumer Information Center, 2002). Early detection has been associated with favorable prognosis, but advanced disease can lead to metastasis to the bones and lungs. It has been estimated that 37,000 men in the US die from prostate cancer each year (Brink, 2000).

The cost of prostate cancer is great for both the individual and society. According to the American Cancer Society (ACS) (2000), the total annual cost of cancer in the US is $180.2 billion. This figure takes into account direct medical costs and indirect morbidity and mortality costs. Direct costs refer to all health expenditures including care provided by physicians and other health care professionals, cost of health care facilities, laboratory fees, and drugs. Over one-half of direct medical costs is associated with three cancers: breast, lung, and prostate. Prostate cancer costs a total of $5 billion each year. However, the dispersion of these dollars is highly dependent on the stage of the cancer at diagnosis. If prostate cancer is localized at the time of diagnosis, the annual cost of direct care ranges from $10,000 to $20,000 per patient. If, however, the disease is advanced at the time of diagnosis, the annual cost increases dramatically to $30,000 to $100,000 per patient (Grover, Zowall, Coupal, & Krahn, 1999).

Although not all prostate cancers are amenable to detection by simple screening, digital rectal examination (DRG) is an economical and minimally invasive test that can be highly sensitive when performed by a well-trained examiner. The sensitivity of the DRE can be enhanced by the addition of serum prostatic specific antigen (PSA) assessment. Due to the magnitude of costs, both human and financial, and the relative ease of screening, various national health care organizations, including the American Urological Association (AUA), the ACS, and the National Comprehensive Cancer Network have recommended that all males age 50 and over (age 45 for men at high risk) be provided with information regarding prostate cancer and offered annual prostate cancer screening (ACS, 2002a).

The cause of prostate cancer is unknown. While men of all racial and ethnic backgrounds are at risk, the disease burden is not equally shared leading to speculation of the possible causal links as being genetic, dietary, and socioeconomic factors. Asian men have the lowest incidence of prostate cancer (2/ 100,000) (Glover et al., 1998), but migration to the US produces a substantial increase in incidence rate. Black men living in West Africa have very low rates, but African-American men are exceedingly vulnerable for both morbidity and mortality (249/100,000) (Glover et al., 1998; Gregg, 1994). In the US, the incidence of prostate cancer approaches 200,000 cases each year; of these cases, it was estimated that between 30,000 and 40,000 deaths will be attributed to the disease (Brink, 2000; National Cancer Institute, 2002). Nationally, African-American men are diagnosed with prostate cancer up to 70% more frequently than are white men (ACS, 2002b); in the state of Florida, the incidence among African-American men is 66% higher than the rate for white men (Florida Prostate Cancer Task Force, 2000). Prostate cancer in African-American men is at more advanced stages at time of diagnosis, and they die from prostate cancer at more than twice the rate of any other group (ACS, 2002c; Brink, 2000; Centers for Disease Control (CDC), 2002; Maloney, 1999; National Cancer Institute, 2002; New Jersey Department of Health and Senior Services, 2000). In 1998 in Florida, the mortality rate for prostate cancer in black men was 190% higher than in white men (Florida Prostate Cancer Task Force, 2000).