Black men are twice as likely to die of prostate cancer than white men – and the disparity is largely driven by who has access to high-quality treatment, a new study indicates.
An analysis of more than 306,000 nonmetastatic prostate cancer cases shows that when black and white patients received the same treatment, they were equally likely to have survived the disease 10 years after diagnosis – suggesting socioeconomic status and other barriers to care may be driving the poorer overall outcomes for black men.
The findings underscore that “efforts are needed to address the modifiable social factors contributing to racial disparity in prostate cancer,” researchers from the University of Michigan and more than a dozen universities and hospitals across the U.S. said.10 Worst Communities for Cancer
To measure a broad swath of patients and treatment types, researchers compared prostate cancer outcomes for black and white men across three cohorts: a population-based cancer registry, four clinical trials with standardized treatment and follow-up care, and five medical facilities run by the Veterans Health Administration, considered an “equal-access” health care system.
The analysis of the cancer registry – containing patient-level data for more than 296,000 menbetween 2004 and 2013 – indicates that among men diagnosed around the same stage of the disease, those who were black were more likely to die of prostate cancer than those who were white.
Yet among those who were treated at Veterans Affairs medical centers – where patients presumably had access to the same treatment – black and white men had similar health outcomes. In the clinical trials, meanwhile, black men appeared to fare slightly better than white men, the study, published Thursday in JAMA Oncology, found.
“To a large extent, health inequalities by race are due to differences in the quality of treatment received,” researchers from Johns Hopkins University, who were not affiliated with the study, wrote in an accompanying commentary.[
In the Veterans Affairs and clinical trial groups, patients were treated with radiotherapy and underwent surgery. Among those in the larger patient registry, men with prostate cancer were treated with hormone therapy, radical treatment or "conservative management” – essentially active surveillance of the disease for low-risk patients.
Black men in the cancer registry generally saw greater barriers to quality health care, including measures like income, insurance status, education level and housing, the study notes. Black men with prostate cancer were often diagnosed at a later stage of the disease and received less care that followed guidelines for best practices.
Researchers said the findings demonstrate a "clear racial health inequity” that is driven by social, not biological, factors, though the data don’t address the potential genetic risk of developing prostate cancer.
"African Americans, other minorities, and the poor in general often experience disparate quality of care or no care at all,” the Johns Hopkins researchers said in the commentary. "Although race does not matter biologically, race still matters.”[
Black prostate cancer patients also were at higher risk of dying of a noncancer cause within 10 years of diagnosis, the cancer registry analysis indicates. Even after adjusting for factors like age, socioeconomic status, treatment and diagnosis stage, black prostate cancer patients in that cohort were 4.4% more likely to have died of any cause than white patients a decade after diagnosis.
"Our study suggests we must focus not only on the prostate cancer diagnosis but also on improving general health status, even in those with high-risk disease,” the study says. That’s especially key for patients with chronic conditions like cardiovascular disease and diabetes, researchers note, because some prostate cancer treatments can worsen those health issues.
"We as health care professionals are likely to have the greatest effect on improved outcomes for African American patients with prostate cancer by ensuring that they get the same care as white patients, not just in clinical trials but throughout the national health care system,” the Johns Hopkins commentary said.
By Gaby Galvin
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