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Barriers to timely diagnosis and treatment of prostate cancer in black men arise from lower socioeconomic status

Black men have over twice the rate of prostate cancer as white men, and it tends to develop at a younger age in black men. A study in North Carolina among men diagnosed with prostate cancer found that, despite less education, black men are aware of their increased risk of prostate cancer, the importance of treatment, and their responsibility for their health.

Obstacles to their timely diagnosis and appropriate care appear more likely to arise from reduced access to and continuity of care resulting from their worse socioeconomic position rather than less information or culturally based misunderstanding. Black men have less complete insurance coverage, less convenient health care settings, and less flexible work circumstances which create barriers that their knowledge and intentions do not overcome.

Researchers, supported in part by the Agency for Healthcare Research and Quality (HS10861), identified 207 black men and 348 white men recently diagnosed with prostate cancer from the North Carolina Cancer Registry. Black men were younger, and had less education, job status, and income than white men. Black men were no further than white men from medical care.

Nevertheless, they had less access to care. They had poorer medical insurance coverage, more use of public clinics and emergency wards, less continuity of care with a primary care doctor, and more often omitted physician visits they felt they needed. Black men also expressed less trust in doctors. Yet, black men accepted greater responsibility for their health than their white counterparts.

For example, black men more often requested the tests that diagnosed their cancers, which resulted more often from routinely ordered screening tests for white men. Also, black men expressed less interest in nontraditional treatments for their cancer. The majority of men in both groups reported an abnormal prostate-specific antigen (PSA) test as the first evidence of prostate cancer.

More details are in "Hidden barriers between knowledge and behavior: The North Carolina prostate cancer screening and treatment experience," by James A. Talcott, M.D., S.M., Pamela Spain, Ph.D., Jack A. Clark, Ph.D., and others, in the April 15, 2007 Cancer 109(8), pp. 1599-1606.

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