Determinants of Prostate Cancer Screening in a Sample of African American Military Servicemen

Military Medicine, May 2006 by Joseph, Hyacinth J

Self-efficacy

For the three self-efficacy statements, scores ranged from 2 to 6, with a mean of 3.7 and SD of 0.64, respectively. Ninety-three percent of respondents (n = 94) either "agreed or strongly agreed" that they were responsible for their own health. These individuals were significantly more likely to report having had the PSA test (p

Age

Before analysis, the age of the respondents was placed into five age groups: 45-50,51-56, 57-62,63-68, and 69 and above. The findings revealed that the highest rates of screening with the PSA were reported by men in the 63- to 68-year age group (86%), and lowest rates were among men in the 45- to 50-year age group (38.5%). These findings, however, were not statistically significant (p = 0.45).

Care Location

No significant findings were noted for PSA screening based on the specific locations where the men reported receiving their medical care (p = 0.78). The highest percentage of screeners was reported by men receiving care at Army (60%) and Air Force (57%) facilities. Except for the two locations with very small representations (Marine Base Clinic and the Veterans Administration), all remaining sites were almost evenly divided in the percentage of men who reported they had been screened with the PSA test (41-47% range).

Military Status

Three groups were used for this analysis (active duty, retired, and family member). No significant relationship was found for PSA screening based on military status (p = 0.25). However, respondents were more likely to report having been screened with the PSA test if they were retired (62%). The largest percentage of nonscreeners was among active duty servicemen (56%).

Provider Recommendation

A significant finding was noted for PSA screening based on the health care provider's recommendation (p = 0.001). The respondents were more likely to report having been screened with the PSA test (65%) when a health care provider recommended it. Seventy-five percent of respondents who reported that screening had not been recommended by health care providers (n = 21) also reported never having had the PSA test. Additional analysis for military status and provider recommendations revealed that health care providers were more likely to recommend PSA test for Department of Defense (DoD) beneficiaries who were retired (71%) rather than for active duty personnel (23%). This finding was statistically significant (p = 0.001).

Discussion

Researchers have identified socioeconomic status (primarily cost and access to health care services) among the major barrier to prostate cancer screening for African American men.3132 When this economic barrier is removed, there is overwhelming evidence that many African American men are still not being screened for prostate cancer and are reporting that health care providers do not recommend screening. Despite having completed physical examinations within the previous 12 months (69% of the sample), only 32% of the men reported they had been screened within the PSA test. Respondents were more likely to report having been screened if they were older, retired, and when a health care provider recommended it. Active duty servicemen reported the lowest rates of screening. This is a matter of great concern, since studies have shown that the younger African American male may have a more aggressive form of the disease with subsequent poorer outcomes from treatment. Data from the Surveillance, Epidemiology and End Result Registry show that mortality rates for patients (between ages 45 and 69 years) who were diagnosed with prostate cancer from 1996 to 2000 were three times greater in African American men compared to Caucasian men.19 Furthermore, the military's mission of combat readiness makes it even more critical that the younger African American male be screened to optimize treatment options and enhance survival patterns.