Al Roker, America’s longtime beloved weatherman, journalist and television personality publicly revealed his prostate cancer diagnosis alongside his TODAY show co-hosts on Nov.6. For years, Al has been a vocal advocator for men’s health and has actively taken part in annual prostate cancer PSA’s to encourage men, especially Black men to be proactive about their health and get their routine checkups.
“You hear the word cancer and . . .your mind goes . . . to [the] next level,” Al reflects as he recalls the moment his urologist Dr. Vincent Laudone of Memorial Sloan Kettering Cancer Center gave him the news. “I wanted to go public with this because [1 in 7]* men are going to be diagnosed with prostate cancer in their lifetime . . . [and] for African American men . . . it’s more deadly.”
For Black men, the reality of a prostate cancer diagnosis is far greater than their White counterparts and twice as deadly. In fact, 1 in 7* African American men will be diagnosed with prostate cancer in their lifetime. Al states, “The problem for African American men [being more affected by prostate cancer] is . . . any number of reasons from genetics to access to health care, . . . so we want to make it [information] available and let people know they got to get checked.”
Representation matters. Despite showing an overwhelming majority in prostate cancer diagnoses and related deaths, African American men are still significantly underrepresented in prostate cancer clinical trials.
Clinical trials are research studies that involve the use of volunteer human participants to explore if an investigational drug is safe and effective for the general public to use.
There are a few possible reasons why participation in clinical trials among African American men is low:
- Lack of awareness, physician bias, and assumed unwillingness to participateA primary barrier for African American men to participate in clinical trials is simply a lack of access to information. Unfortunately, physicians often make assumptions about the willingness or lack thereof of African Americans to participate in clinical trials and are less likely to initiate a conversation and inform their African American patients of available clinical trials for which they may qualify..
- Distrust in healthcare systemAfrican Americans generally have a distrust in the medical system due to a history of exploitation and inhumane treatment from the medical community in the United States. Unethical experiments such as the Tuskegee Syphilis Experiment has made a long-lasting impact on how African Americans view their healthcare providers. This is particularly evident among African American men. Unfortunately, Black doctors only make up about 5% of active physicians according the Association of American Medical Colleges’ 2018 U.S. physician workforce data. Distrust has been well documented as a reason for lower participation of Blacks in clinical research and low prevalence of Black doctors may be a contributing factor to African American men’s willingness to participate in clinical trials.
- Physician bias and perceived patient intelligenceA van Ryn and Burke study found that physicians typically perceived African American patients as less intelligent and two-thirds more likely to adhere to the physicians prescribed method of care than White patients. Based on the results from this study, it’s possible that the implicit bias of some physicians influences a physician’s ability or willingness to engage in a conversation about clinical trials, because they assume that their African American patients will not understand. This bias further contributes to the gross underrepresentation of African American men in clinical trials.
- Racial bias in perceived pain assessments and treatmentAfrican Americans are often subjected to false perceptions of biological differences concerning pain when compared to White Americans. This misconception often leads to healthcare providers under assessing the level of pain African American patients experience and are therefore less likely to take action with proper care and adequate treatment options. Often the “wait-and-see” approach to patient care is taken versus proactive approaches. There are no symptoms in early stages of prostate cancer. And unfortunately, for African American men, if their prostate cancer has progressed and they’re experiencing discomfort, their pain is likely to be minimized by their physician. This further contributes to the distrust African Americans feel towards the healthcare system and could also be a reason why African American men often choose to not go to the doctors – feeling that their concerns will not be addressed or validated.
- Men – regardless of race, don’t go to the doctorA survey from the Cleveland Clinic’s annual “MENtion It” campaign revealed that 65% of men avoid going to the doctor as long as possible. And when they actually do go, 20% aren’t honest with their doctors about their health and 37% said they withheld information from their healthcare providers. Medical avoidance is a real issue for all men.
In an interview with Al Roker and co-hosts on the TODAY show Dr. Carol Brown, a cancer surgeon and Director for Diversity and Health Equity at Memorial Sloan Kettering Cancer Center states, “African American men are 50% more likely to get prostate cancer and unfortunately they’re twice as likely to pass-away from prostate cancer than White men are in the United States.” She continues, “Screening saves lives. And African American men need to get screened . . .starting at age 40.”
It’s unclear why African American men are more susceptible to prostate cancer and have greater fatality rates than other racial groups. More research is needed. Unfortunately, due to a lack of representation of African American men in prostate cancer clinical trials, Black men continue to be at a disadvantage.
The presence of African American men is needed in prostate cancer clinical trials. With their participation, researchers can study the biology of prostate cancer in African American men as well as the effects and potential risks of current and future treatment options.
Participation is completely voluntary, and participants can stop at any time. African American men who are interested in participating in a prostate cancer clinical trial, should speak to their healthcare provider or visit BMSStudyConnect.com
*Source: Centers for Disease Control and Prevention. United States Cancer Statistics: Male Urologic Cancers. USCS data brief, no 21. https://www.cdc.gov/cancer/uscs/about/data-briefs/no21-male-urologic-cancers.htm