Prostate cancer hits black men especially hard
Erin Marcus | 10/24/2012, 9:06 a.m.
The studies the USPSTF reviewed didn’t include many black men, and most were done in Europe. Nonetheless, the panel didn’t make a separate recommendation for blacks. Instead, it stated that because so few black men were in the studies, “no firm conclusions can be made about the balance of benefits and harms of PSA-based screening in this population,” and described PSA screening based on race as “problematic … in the absence of data.”
The panel’s report also cited a recent large U.S. study that did include a large number of black men with early prostate cancer and found no difference in survival at 12 years between those who underwent aggressive prostate surgery and those who were closely monitored but didn’t receive prostate cancer treatment.
The leading black physicians’ organization, the National Medical Association (NMA), vehemently disagreed with the USPSTF’s recommendation.
“It just doesn’t make sense,” said Dr. Cedric Bright, a general internist who is an associate professor of medicine at the University of North Carolina at Chapel Hill and a former NMA president. “I’ve seen enough prostate cancer that started early and was more aggressive.”
He added that the panel’s conclusions “may be more generalizable to those who are of European background. There are very few African Americans in the studies.”
In a statement issued in response to the USPSTF recommendation, the NMA describes PSA screening as “the best method to detect early stage, curable prostate cancers.”
The NMA supports the American Urologic Association’s screening guidelines, which include beginning PSA screening at age 40. Guidelines include a doctor’s office rectal exam as part of the screening, and assessing a man’s risk based on his age, ethnicity, family history and aspects of his PSA result, such as how much it has increased over the past year and whether it is high compared to the size of his prostate.
It also encourages men to engage in a discussion of risks and benefits with their physicians, and advocates educating people in the community about prostate cancer and making health care easier to obtain.
The NMA statement cites a 2010 autopsy study of more than 1,000 black and white men in Detroit suggesting that prostate cancer grows more rapidly in black men and/or changes from an indolent to an aggressive form sooner in blacks.
Bright believes there’s a need for more research to study PSA screening’s effectiveness among black men. In the meantime, however, he is worried that insurance companies will respond to the USPSTF’s recommendations by deciding not to cover PSA screening. He says he has already begun to see a “backlash” of men deciding not to be screened.
And while Marc Henderson is aware of the USPSTF’s recommendation, he says it doesn’t affect his decision to get the PSA. “Yes, statistics may be good for the population, but everything in life is individual,” he said. “African American males need to be cognizant of their health.”
Dr. Erin Marcus is a general internal medicine physician and writer based in Miami.
New America Media