Access To Care Linked To Prostate Cancer Outcomes
Previous studies have shown that African-American men do not live as long after being diagnosed with prostate cancer as Caucasian men live.
However, new research reported in the medical journal Cancer suggests that factors such as poverty and a lack of education - rather than race - may be primarily to blame.
"If you have patients all at the same level on the socioeconomic scale, with equal housing, nutrition, access to care, and optimum therapy, race plays no role," notes lead researcher Dr. Xianglin L. Du.
Dr. Du is an associate professor of epidemiology at the University of Texas Health Science in Houston. Researchers from the M.D. Anderson Cancer Center in Houston also contributed to the study.
Prostate cancer is the most common cancer, excluding skin cancers, in American men. The American Cancer Society (ACS) estimates that during 2006, about 234,460 new cases of prostate cancer will be diagnosed in the United States.
About one man in six will be diagnosed with prostate cancer during his lifetime, but only one man in 34 will die of this disease. A little over 1.8 million men in the US are survivors of prostate cancer, states the ACS.
Prostate cancer is a leading cause of cancer death in American men. The ACS estimates that 27,350 men in the US will die of prostate cancer during 2006. Prostate cancer accounts for about 9 percent of cancer-related deaths in men.
Dr. Du and his colleagues studied a database of more than 61,000 prostate cancer patients ages 65 and older, all of whom had some form of health coverage.
The researchers found that education, poverty, and income levels were better indicators of survival than race.
Age, disease stage, and treatment methods also had an impact.
Men of lower socioeconomic status did not live as long after diagnosis as did wealthier patients, the team found.
In fact, men who placed in the bottom 25 percent in terms of income had a 31 percent higher risk for death, compared to more well-off patients. That risk did not change significantly when the team adjusted for race.
The researchers also found that "a large proportion" of African-American and Hispanic patients were poorly educated, with a much higher likelihood of having incomes at or below the poverty level, compared with Caucasian patients.
Just over 73 percent of African Americans and close to 61 percent of Hispanics placed in the bottom quarter in terms of income, compared with about 18 percent of Caucasians.
The sample of prostate cancer patients is the largest ever studied, notes Dr. Du. The data was taken from the federal government's Surveillance, Epidemiology, and End Results (SEER) cancer database.
All patients had been diagnosed with local (limited to the prostate) or regional stage (spread outside the prostate) carcinoma between 1992 and 1999.
A previous study in Cancer found that all groups generally receive the same level of care, although African-American men are more likely to choose radiation therapy, while Caucasian men more often opt for invasive surgery to eradicate the cancer.
However, other studies have shown that African-American men are more likely to get prostate cancer and to be diagnosed at later stages, says Dr. Thomas Fogel, a radiation oncologist in Ventura, Calif., and a volunteer with the ACS.
While it is not yet known why African-American men might be more prone to the disease, late diagnoses appear to be related to socioeconomic issues as well, he notes.
"Men who do not have the ability to get into the system and be diagnosed and treated are going to be doing worse than men who have access to the system," explains Dr. Fogel.
In this study, he says, "you actually have statistics on a disease that validates that which we all intuitively know is an enormous issue."
"The implication, for me, is that if the largest variable for outcome is socioeconomic status, that is basically a surrogate for access to care," he says. "We need to do something."
Always consult your physician for more information.
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In general, all men are at risk for prostate cancer. However, there are specific risk factors that increase the likelihood that certain men will develop the disease, including the following:
age
Age is a risk factor for prostate cancer, especially men age 50 and older. More than 70 percent of all prostate cancers are diagnosed in men over the age of 65.
race
Prostate cancer is nearly 60 percent more common among African-American men than it is among Caucasian-American men.
Japanese and Chinese men native to their country have the lowest rates of prostate cancer. Interestingly, when Chinese and Japanese men immigrate to the US, they have an increased risk and mortality rate from prostate cancer, when compared to their native populations. In Japan, the incidence of prostate cancer has increased as Western diets and lifestyles have been adopted.
diet
Research suggests that the diet consumed in Western industrialized countries may be one of the most important contributory factors for developing prostate cancer.
obesity
Obesity not only contributes to diabetes and high cholesterol, but has also been associated with some common cancers, including hormone-dependent tumors such as prostate, breast, and ovarian cancer.
environmental exposures
Some studies show an increased chance for prostate cancer in men who are farmers, or those exposed to the metal cadmium while making batteries, welding, or electroplating.
Additional research is needed in this area to confirm whether this is a true association.
family history of prostate cancer
Having a father or brother with prostate cancer doubles or triples a man's risk of developing this disease. The risk is even higher for men with several affected relatives, particularly if the relatives were young at the time of diagnosis.
genetic factors
Some genes, when altered or mutated, give a higher risk for uncontrolled cell growth, which, in turn, can lead to tumor development. These genes have various names, but overall are referred to as "cancer susceptibility genes."
Approximately 5 percent to 10 percent of all prostate cancers and 45 percent of cases in men younger than age 55 can be attributed to a cancer susceptibility gene that is inherited as a dominant trait (from parent to child).
other factors
Researchers have looked at whether men who have had a vasectomy, benign prostatic hyperplasia (BPH), or those who have been exposed to a sexually transmitted disease are at increased risk for prostate cancer.
Some studies suggest a link, while others do not support these claims.
Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop cancer, while others develop cancer and have no known risk factors.
Knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.
Always consult your physician for more information.
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