Inequities and biases abound in the U.S. healthcare system, preventing minorities from obtaining the care they need. Like many diseases, cancer affects numerous populations in the U.S. However, Black men are more likely to die of prostate cancer compared to white men.
The prostate is a small gland that sits just below the bladder and is part of the male reproductive system. The gland aids in the generation of hormones and sperm, as well as the control of urine flow. Prostate cancer develops when cells in the prostate become uncontrollably proliferated. This happens when there are mutations in the DNA of prostate cells. Inherited genes that raise the chance of cancer, and acquired mutations through harmful chemical exposure, are possible causes of prostate cancer.
Not only are adult Black men more likely than white men to have this disease, but they also develop it at an early age. Prostate cancer can occur at age 40 and spread rapidly by age 50. According to a 2020 study published in JAMA, after a median follow-up of 7.6 years, 59.9% of Black men with low-risk prostate cancer had disease progression, compared to 48.3% of non-Hispanic white men. Similarly, within the study’s time frame, 54.8% of Black men underwent definitive treatment, compared to 41.4% of non-Hispanic white men.
The notion that Black men are more likely to get aggressive prostate cancer is not new; such inequalities are not uncommon in the cancer field. Historical and institutional racism, racial biases, and entrenched socioeconomic factors ultimately contribute to these gaps in cancer. When evaluating these factors, it is important to acknowledge the mistrust many African Americans have towards U.S. healthcare as a result of historical exploitation and prejudice. Such examples are the infamous Tuskegee syphilis study, as well as the case of Henrietta Lacks in the cancer field—the story is as much about suffering from cancer as it is about a lack of bioethical standards at the time.
Some scholars have concluded that racial biases in the medical system drive doctors to provide poor health care to patients of color, contributing to increased rates of morbidity and mortality. The composition of the medical workforce reflects the absence of appropriate representation. Even though Black Americans make up 13.4% of the U.S. population, only 2.3% of practicing oncologists self-identify as Black or African American. In addition, ethnic/racial groups reportedly comprise only 3–7% of biomedical research faculty in the U.S., despite having a greater representation at the Ph.D. and postdoctoral levels. This lack of diversity in the oncology workforce has grave consequences for Black patients as it can obfuscate correlations between disease traits and treatment response, reinforcing health inequities.
However, sharing a racial or cultural background with one’s doctor helps promote communication and trust. A 2019 NBER study found that Black men seen by Black doctors agreed to more invasive, preventive services than those treated by non-Black doctors. While efforts to address these disparities grow, cultural and social norms remain obstacles for Black men to navigate the system. Norms surrounding masculinity can become barriers to Black men in receiving the health care they need, according to a University of Michigan study published in the journal Social Work.
While a personal matter, sexual health is a major concern in the case of prostate cancer. Men are typically hesitant to ask healthcare professionals, friends, or family members questions. According to some theories “toxic” has an impact on physical health. Toxic masculinity may deter some men from seeking help for potential health concerns. Asking for help can cause emotions of inadequacy, weakness, and a sense of being “less of a man” in some men.
More Black lives can be saved with prostate screening than those at lower risk. When prostate-specific antigen (PSA) screening tests were introduced in the 1990s, the death rates of Black men dropped the highest. Because of the substantial association between midlife PSA levels and the risk of aggressive prostate cancer, Black men should practice frequent and early screening. Men between the age of 55 to 69 should consider PSA screening and regular prostate exams, according to the Centers for Disease Control and Prevention (CDC).
Although prostate cancer is uncommon in men under the age of 45, a 2020 study suggests that high-risk Black men should undergo prostate screening at this age. Any clinical suspicion of prostate cancer can be raised by these screening tests. Although prostate cancer is rare in males under 45 years, a National Institutes of Health (NIH) study suggests that Black men at high risk should consider prostate screening around this age. The tests can raise any clinical suspicion of prostate cancer.
Lifestyle changes can also help lower the risk of prostate cancer such as exercising, maintaining a healthy weight, and not smoking. However, Black men should not have to deal with the medical system and cancer risks alone. Brotherhood and community are advocacy tools that can enable Black males not only to check in with one another but also speak up for one another.