Prostate cancer in black men of African-Caribbean descent

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

The morbidity and mortality of prostate cancer in black men in the US is clearly alarming. Accordingly, much emphasis has been focused on improving detection and treatment for this minority group (Boyd, Weinrich, Weinrich, & Norton, 2001; Florida Prostate Cancer Task Force, 2000; Moul, 2000; Shelton, Weinrich, & Reynolds, 1999; Stallings et al., 2000; US Department of Health and Human Services, 2000; Weinrich, Reynolds, Tingen, & Starr, 2000).

African-Caribbean men, particularly Jamaican men, have the highest rate of prostate cancer in the world (304/100,000) (Glover et al., 1998). Due to the prevalence of infectious diseases, the life expectancy for men living in Haiti is only 49.7 years, with only 8.4% of the men expected to live past 60 years (World Health Organization, 2001a). For men of African descent, the age-specific risk for prostate cancer increases at age 45 years (ACS, 2001; AUA, 2001). Therefore, few men living in Haiti survive into the years associated with increased risk, and the incidence rate of prostate cancer among black men living in Haiti is unknown. However, relocating from Haiti to the US extends the life expectancy of Haitian men by 19 years (World Health Organization, 2001b), thereby giving Haitian-born men living in the US the opportunity to experience age-related prostate changes.

Theoretical Framework

Purnell's Model for Cultural Competence (Purnell & Paulanka, 2003) was constructed specifically to assist "health-care providers ... to provide holistic, culturally competent, therapeutic interventions, health promotion, health maintenance, disease prevention, and health teaching" (p. 8). Listed among the purposes of the model are to: (a) provide a framework for all health-care providers to learn inherent concepts and characteristics of cultures, (b) interrelate characteristics of culture to promote congruence and facilitate the delivery of consciously competent care, and (c) provide a framework that reflects human characteristics such as motivation, intentionality, and meaning. Accordingly, analysis of cultural data provides the foundation for the adoption, modification, or rejection of health-care treatment regimens according to the needs of the individual and the impact on the quality of the individual's health-care experiences and personal existence.

The term "African-American" has been broadly used to describe all black people living in the US. Use of such sweeping categorization pays little regard to the existence of subcultures within the black community at large. There is much diversity within this broad population, and there are specific attributes of ethnicity that exceed limitations of the definition of race. While members of the black race may share similar primary, genetic characteristics, skin color cannot be equated with behavior. Purnell and Paulanka (2003) pointed out that members of subcultures, composed of immigrants may maintain identifiable secondary characteristics that influence how they view the world and behave in it. Pertinent among the secondary characteristics are socioeconomic status, length of time away from the country of origin, education, reason for immigration, and legality of immigration status.