WEDNESDAY, Jan. 19, 2022 (HealthDay News) – Even in an environment where white and black people have equal access to health care, black Americans are doing worse than whites in terms of prostate cancer, new research shows.
A review of nearly 8 million men seen in U.S. Veterans Affairs (VA) hospitals found that black veterans had nearly twice the incidence of localized and advanced prostate cancer like white people.
But there was also a hint of good news: when they had the same treatment, the black and whites had similar outcomes.
“It is important that African Americans who received definitive primary treatment had a lower risk of [cancer spreading]”Said study co-author Dr. Isla Garraway, an associate professor in the urology department at David Geffen Medical School at UCLA in Los Angeles.
But because they were not diagnosed early, more blacks had metastatic or cancer that had spread, the researchers found.
“Significant differences observed in prostate cancer incidence resulted in a constant difference in prostate cancer metastases in African-American veterans, compared to white veterans despite their almost equal response to treatment,” Garraway said.
As many have recognized, equal access to care has the potential to reduce disparities in important outcomes among racial groups, Garraway said. It is well documented that blacks in the United States often have reduced access to health care and may receive poorer quality of care compared to white Americans. Because the VA system provides equal access to care, the researchers hypothesized that blacks would benefit from equal conditions.
“Treatment within the VA system reduces some of the differences in outcomes reported in non-VA populations,” Garraway said. “However, the increased overall incidence of prostate cancer remains a critical barrier to eliminating racial differences.”
Blacks have a higher risk of prostate cancer than whites, and blacks often have worse results and are later diagnosed with more advanced cancer, the researchers noted.
Nevertheless, their analysis showed that even in the VA system, which is open to all veterans, there are differences between black and white men.
Garraway is not sure why these differences continue in a system with equal access and treatment.
“Many factors influence prostate cancer development and response to treatment, including tumor biology, access to care and quality of care,” she said, adding that “a systematic evaluation of these factors is needed” to eliminate these racial differences in the future.
The researchers found that when black and white men were examined prostate cancer, blacks had a 29% higher risk of cancer. They were also younger at the time of diagnosis.
But analyzing more than 92,000 men, the researchers saw that blacks diagnosed and treated early definitely had the same outcomes as whites.
The report was published online Jan. 18 in the journal JAMA network open.
“Something is causing blacks to receive less aggressive treatment compared to whites,” said cancer expert Dr. Anthony D’Amico, a professor of radiation oncology at Harvard Medical School.
If they have other chronic diseases that make submission aggressive cancer treatment a problem, which could explain some of the differences the researchers found, he said.
Some patients may also choose not to receive treatment due to some of its side effects, said D’Amico, who was not part of the study.
Race can also play a role, he pointed out. “I hope not,” he said, adding that some doctors could refrain from aggressively treating blacks.
D’Amico said that every man, regardless of race, who has been diagnosed with prostate cancer should talk to his doctor about the best treatment. “They have to say, ‘Doctor, what is the best possible treatment for this cancer to have the highest possible cure rate, and then tell me the side effects,'” he said.
It also recommends that men get it PSA screening infect cancer early when it is most curable. The PSA (prostate-specific antigen) blood test measures a protein produced by the prostate.
“Screening saves lives, no doubt about it,” D’Amico said. “I think that PSA screening is necessary for every man, especially for high-risk populations, especially African-Americans and Hispanics.
“I tell people in the high-risk population, as well as anyone who has a father or brother with the disease, that they should get an initial PSA at 35 and then every year starting at 40,” D’Amico said.
The U.S. National Cancer Institute has more on prostate cancer treatment.
SOURCES: Isla Garraway, MD, PhD, Associate Professor, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles; Anthony D’Amico, MD, PhD, Professor, Radiation Oncology, Harvard Medical School, Boston; JAMA network open, Jan. 18, 2022, online