Written by Dr. Brian Klausner and Dr. Nerissa Price, WakeMed Center for Community Health, Innovation and Equity
Prostate cancer is the most common cancer among U.S. men, outside of skin cancer, and the second most deadly. In 2020 alone, over 37,000 U.S. men died of this disease. As with too many other diseases and cancers, there are racial disparities in terms of mortality — with Black men being twice as likely to die from prostate cancer compared to the general population[1]. Wake County, while the healthiest county in North Carolina, is not immune to these deadly disparities, with local outcomes closely matching national trends[2].
Possible Reasons for Racial Disparities in Prostate Cancer Mortality Rates
The reasons underlying prostate cancer-related disparities are not fully known, in part due to the historical underrepresentation of Black men in prostate cancer research. Some studies suggest genetic predispositions toward mutations resulting in more aggressive cancers. However, more recent evidence demonstrates that the main factors driving racial disparities appear to be, unfortunately, the common and familiar issues related to socioeconomic status, environmental exposure, and associated lack of access to care[3]. In a state without Medicaid expansion, and in a county where a third of residents in certain census tracks do not have health insurance, access to care is undoubtedly a contributor to these demonstrated disparities in local outcomes [4].
Impact of Prostate Cancer Screening
For decades, there have been evolving efforts to develop effective screening strategies that can result in early, asymptomatic detection of prostate cancer to allow for earlier treatment and better outcomes. The prostate screening antigen (PSA) blood test was developed in the 1980s. And while we have seen an approximate 50% reduction in prostate cancer-related mortality since that time, it is unclear if this is related to the screening itself or improvements in treatment. While increased screening has resulted in a doubling of prostate cancers diagnosed, there are concerns regarding overdiagnosis and overtreatment of cancers that would have never become symptomatic — cancers that would have been indolent and non-progressive. Those risks have been reduced recently, however, with increased strategies involving “active surveillance” for low-risk cancers instead of aggressive care. Regardless, these uncertainties have resulted in confusion regarding prostate cancer screening for both patients and their medical providers who have struggled to provide advice based on conflicting and often changing guidelines.
A recent study published earlier this month in the New England Journal of Medicine (NEJM) provided a much-needed update on guidance by adjusting for evolutions of treatments, including “active surveillance,” assessing longer follow-up periods, and importantly, specifically focusing on outcomes in Black men. The results were revealing and significant: screening for prostate cancer proved to be much more effective than previously believed. Earlier studies with shorter follow-ups demonstrated that 23 cases of prostate cancer would have to be diagnosed to save one life. In the NEJM study, this number dropped down to 11 to 14 in the general population — and 8 to 12 in Black men[5]. These numbers are closer to other accepted cancer screening tests and should result in a push to clarify current recommendations and, more importantly, encourage screening, especially in Black men.
The NC Minority Prostate Cancer Awareness Action Team
Since the 1980s, there has been a local group comprised of Black community leaders and physicians — the NC Minority Prostate Cancer Awareness Action Team — currently led by Dr. James Smith and Dr. Leroy Darkes, who have been advocating for improved prostate cancer screening, access to care and, perhaps most paramount, increased patient empowerment and education in the community. In the context of this new evidence, their work and message are as important, and urgent, as ever. As we continue efforts around community collaborations to advocate for the changes needed to address health care disparities on a broader level, we also need to leverage and build upon the historic work of our local leaders and their expertise in our communities.
Upcoming Prostate Cancer Screening and Health Fair
On June 18, the Action Team will hold their annual prostate screening and Family Health Fair from 7:30 am to 1 pm at Springfield Baptist Church on 4309 Auburn Knightdale Rd. WakeMed’s Health Lives Here mobile unit will be on-site to provide prostate screenings. Registration is required. Sign up at minorityactionteam.org/knowledge-armory.
Spread the Word!
Please consider sharing this with brothers, sons, husbands, fathers, and friends to help spread the message. Encourage them to talk with their doctors, read the study and attend the health fair to get the information they need to make their own decisions. There is increasing evidence it may just save a life.
About Dr. Brian Klausner
Dr. Brian Klausner has spent his career advocating for patients and driving quality improvement. He joined WakeMed Primary Care in 2011 after working for Boston Health Care for the Homeless Program as the medical director of their Boston Medical Center outpatient clinic.
Dr. Klausner serves as Medical Director for WakeMed’s Community Population Health program, which works to improve the health of uninsured and homeless patient populations. As medical director, he drives collaboration with community partners to ensure patients are connected with a medical home and get the resources they need, whether it is blood pressure medication, counseling, housing or legal assistance. He also serves as Chief Medical Officer of WakeMed Key Community Care, where he advocates for enhancing the quality and coordination of care while reducing costs.
About Dr. Nerissa Price
Dr. Nerissa Price is a hospital medicine psychiatrist for WakeMed Health and Hospitals and serves WakeMed’s Center for Community Health, Innovation and Equity. A Wake County native who received her medical degree and completed a Child and Adolescent Psychiatry Fellowship at the University of North Carolina at Chapel Hill School of Medicine, she is board certified in general psychiatry. Having devoted her career to improving the health of the mentally ill, Dr. Price is passionate about helping others achieve their life’s purpose by maintaining mental health wellness. Through various health care settings, Dr. Price understands that medications are only a part of good mental health care and that a holistic treatment strategy must be developed and coordinated with providers in primary care, as well as alternative and complementary medicine to provide compassionate, evidence-based and affordable behavioral health care.
Sources:
[1] https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-deaths/index.htm
[2] https://s3.us-west-2.amazonaws.com/wakegov.com.if-us-west-2/prod/documents/2022-05/Chronic%20Disease%20Report%202021.pdf
[3] Dess RT, Hartman HE, Mahal BA, et al. Association of Black Race With Prostate Cancer–Specific and Other-Cause Mortality. JAMA Oncol. 2019;5(7):975–983. doi:10.1001/jamaoncol.2019.0826
[4] https://unc.maps.arcgis.com/apps/MapSeries/index.html?appid=5eb9f9d962914ab19e5b454b30637104
[5] NEJM Evid 2022; 1 (6) doi: https://doi.org/10.1056/EVIDoa2200031
