1 Richard Macdonald, Michael Pires, and Ernesto Barbosa June 2017Prostate Cancer in Black Males as Compared to the General Population in Massachusetts Richard Macdonald, Michael Pires, and Ernesto Barbosa June 2017 1
2 Health Disparities Health disparities occur when the rates of disease occurrence vary between a socioeconomic, geographic, or racial group compared to the general population Blacks, who only compose 6% of the Massachusetts population, are subject to health disparities such as prostate cancer 2
5 Prostate Cancer Incidence, Hospitalization, and Mortality Rates in MA Between RacesIncidence rates are 68% higher in blacks as in whites, who compose the majority of the population 14 34% higher rate of hospitalization due to prostate cancer in blacks as in whites 14 124% higher mortality rate among blacks as whites 14 5
6 Genetic Risk Factors for Developing Prostate CancerRisk for developing prostate cancer is affected by polymorphisms in specific genes One controls the absorption of calcium in cells of the small intestine 18 Prostate cells respond to increased calcium intake by multiplying at a faster rate Model of transcription factors attaching to a binding site prior to protein synthesis 20. 6
7 Genetic Risk Factors for Developing Prostate Cancer, ContinuedBlacks are more likely to have the more active allele, leading to more receptor production 18 Since increased calcium absorption leads to a higher risk of prostate cancer, blacks are more likely to suffer from the disease High levels of calcium intake increased men’s risk for advanced prostate cancer People with a family history of prostate cancer are more likely to develop the disease 18 Source 5 7
8 Risk Factors: Obesity Obesity increases calcium absorptionLeads to increased likelihood of developing prostate cancer 4, 18 Detection biases among obese men: 4 Naturally lower PSA levels prevent further screenings Physicians have a more difficult time performing complete digital rectal exams Obese men have larger prostates, increasing the surface area that prostate cancer could occur over 8
9 Risk Factors: Obesity, ContinuedIn addition to higher rates of incidence, obese men are more likely to experience fatal cases of prostate cancer 4 Larger amounts of fat tissue cause the prostate and prostate cancer to move more in obese men 4 Less radiation hits the cancerous mass during radiation therapy, leaving some behind As a result, obese patients who undergo radiation therapy are more likely to experience biochemical recurrence 4 Zakariyya, an obese man from The Immortal Life of Henrietta Lacks 8 9
10 Risk Factors: Insurance and Definitive TreatmentCompared with white men, black men have a significantly lower probability of receiving definitive treatment 11 Black men with high risk prostate cancer are less than half as likely to receive definitive treatment in comparison to white men Largely as a result, black men who develop prostate cancer are more likely to die from the disease Insured black men were less likely to receive definitive treatment than uninsured white men 10
11 Risk Factors: Insurance and Definitive Treatment, ContinuedBlacks are more likely to experience racially discordant physician visits 13 These visits are shorter in length and less patient-centered The patient plays less of a role in decision making White physicians spent less time planning treatment, educating, assessing health knowledge, engaging in conversation, and answering questions of black patients There are 40 times less black urologists in the field than whites 23 As a result, even people with a heightened perceived risk are unlikely to reach out to resources 17 11
12 Risk Factors: Perceived Risk of Prostate CancerBlacks are unlikely to recognize that they are at increased risk for prostate cancer 17 Their lowered perceived rate was directly associated with their socioeconomic status, income, etc. Older men do not see themselves as having a higher risk than young men 17 The lack of education of prostate cancer in blacks may be due to the uncertainty of benefits of diagnostic measures 17 Community based efforts are important to educate and inform blacks about prostate cancer issues and prevalence 12
13 Present Efforts to Educate Prostate Cancer SurvivorsProstate Health Education Network (PHEN) 3 Helps spread knowledge about prostate cancer to combat lack of awareness about prostate cancer Holds and broadcasts summits to find solutions toward ending racial disparities in prostate cancer Broadcasts public service announcements over the radio Creates a survivor network for people who have survived prostate cancer General monthly support meetings Partnered with UMass Medical School and UMass Memorial Health Care 13 Sources 15, 21, 22
14 Recommendations to Reduce Prostate Cancer Risk and DisparitiesPeople at higher risk for prostate cancer, especially blacks, should limit their calcium intake 18 Increased exercise helps protect against aggressive forms of prostate cancer, which are more prevalent in blacks 3, 4 If prostate cancer in an obese man is not far along or of low risk, devoting a few months to weight loss prior to treatment may result in a better outcome 4 Obese men should be educated about their increased risk of recurrence after having a procedure to remove the cancer 4 14
15 Summary Black men have higher incidence, hospitalization, and mortality rates than the general population Blacks are more likely to absorb more calcium resulting from genetics, putting them at higher risk of prostate cancer Since a higher percentage of black men are obese, risk factors resulting from obesity affect blacks disproportionately Black men are less likely to receive definitive treatment for prostate cancer, even if they have insurance Blacks are unlikely to recognize they are at a higher risk of prostate cancer Multiple steps can be taken to help close the disparities black men experience in diagnosis and treatment of prostate cancer 15
16 “Knowing is not enough; we must apply“Knowing is not enough; we must apply. Willing is not enough; we must do.” -Johann Wolfgang von Goethe 16
17 References (1-11) Allison Family Chiropractic. Blue Prostate Cancer Ribbon on Denim. Retrieved from content/uploads/2015/06/Depositphotos_ _m.jpg. Age-Adjusted Rates. Retrieved from https://www.health.ny.gov/diseases/chronic/ageadj.htm Ahaghotu, C., Andriole, G. L., Benjamin, C., Bennett, N., Carter, J. J., Catalona, W., Walsh, P. (2013). PHEN Consensus Statement on PSA Testing for African American Men for the Early Detection of Prostate Cancer. Retrieved from https://rapcancer.wordpress.com/ Allott, E. H., Masko, E. M., & Freedland, S. J. (2013). Obesity and Prostate Cancer: Weighing the Evidence. European Urology, 63(5), doi:http://dx.doi.org/ /j.eururo Black Man in Hospital Bed. Retrieved from Diseases and Conditions: Prostate Cancer. (2017). Retrieved from cancer/multimedia/prostate-cancer/img Diseases and Conditions: Prostate Cancer: Definition. (2017). Retrieved from conditions/prostate-cancer/basics/definition/con Espinoza, S. (2013). Lacks Family Picture. Retrieved from https://sites.google.com/site/tilohelaproject042013/zakarriya. Helfand, B., Kearns, J., Conran, C., & Xu, J. (2016). Clinical validity and utility of genetic risk scores in prostate cancer. Asian Journal of Andrology, 18, 509. Krane, Jenny (2016). Black Patient with White Doctor. Retrieved from Mahal, B. A., Ziehr, D. R., Aizer, A. A., Hyatt, A. S., Sammon, J. D., Schmid, M., Nguyen, P. L. (2014). Getting back to equal: The influence of insurance status on racial disparities in the treatment of African American men with high-risk prostate cancer. Urologic Oncology: Seminars and Original Investigations, 32(8), doi:https://doi.org/ /j.urolonc 17
18 References (12-23) Manski, D. (2015). Prostate Exam. Retrieved from Penner, L. A., Eggly, S., Griggs, J. J., Underwood, W., Orom, H., & Albrecht, T. L. (2012). Life-Threatening Disparities: The Treatment of Black and White Cancer Patients. The Journal of social issues, 68(2), /j x. doi: /j x Prostate Cancer Report for Massachusetts Total. (2013). Prostate Health Education Network. PHEN Logo. Retrieved from https://pbs.twimg.com/profile_images/ /e2f5d65d95d9b847565c2b89fca58a13_400x400.png. Race/Hispanic Ethnicity Report: Health Risk Factors for Massachusetts Total. (2013). Rice, L. J., Jefferson, M., Briggs, V., Delmoor, E., Johnson, J. C., Gattoni-Celli, S., Halbert, C. H. (2017). Discordance in perceived risk and epidemiological outcomes of prostate cancer among African American men. Preventive Medicine Reports, 7, doi: /j.pmedr Rowland, G. W., Schwartz, G. G., John, E. M., & Ingles, S. A. (2012). Calcium Intake and Prostate Cancer Among African Americans: Effect Modification by Vitamin D Receptor Calcium Absorption Genotype. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 27(1), doi: /jbmr.505 Suburban Stats: Population Demographics for Massachusetts 2017 and (2017). Retrieved from https://suburbanstats.org/population/how-many-people-live-in-Massachusetts. Transcription Factor. Retrieved from University of Massachusetts Medical School. UMass Medical School Logo. Retrieved from https://yt3.ggpht.com/- 6mSoRWjuM4E/AAAAAAAAAAI/AAAAAAAAAAA/crGk4vvzvbM/s900-c-k-no-mo-rj-c0xffffff/photo.jpg. University of Massachusetts Medical School. UMassMemorial Logo. Retrieved from The State of the Urology Workforce and Practice in the United States (2017). American Urological Association. 18