![]() ![]() 10 The consistently high mortality rates for Black people across many regions may bolster the argument for genetic predisposition. 4 In the US, African American men are more likely to receive a diagnosis of prostate cancer at an advanced stage and twice as likely to die from prostate cancer than white men. 13 In 2008–2010, the lifetime risk of a Black man in England dying from prostate cancer was 8%, compared with 4% for a white man and 2% for an Asian man. In England, the incidence rate of prostate cancer was more than twice as high among Black people (rate ratio 2.1) than among white people in 2013–2017. Some studies have evaluated epidemiological data for prostate cancer by racial groups in the same region. 8 – 10 A 2020 publication that estimated global cancer burden found the highest mortality rate for prostate cancer in the Caribbean (27.9 per 100 000), followed by Middle, Southern and Western Africa (24.8, 22.0 and 20.2 per 100 000, respectively), and Micronesia and Polynesia (18.8 per 100 000). 5 – 12 In the Caribbean, prostate cancer incidence rates as high as 304 per 100 000 men have been documented, 5 – 7 compared with 4.7–19.8 per 100 000 in West Africa, 11.5 per 100 000 in Asia, 113.6 per 100 000 in Canada and 111.3 per 100 000 in the US. Mortality and incidence rates of prostate cancer vary widely worldwide by region and source, reflecting variance in screening guidelines and health care resources, as well as ethnocultural differences. How are Black people disproportionately affected by prostate cancer? We discuss the current state of evidence and guidance for prostate cancer screening among Black patients in Canada and consider whether guidelines should be re-evaluated to consider differential screening for this high-risk population group. 3, 4 Current guidelines for prostate cancer have very limited generalizability to Black patients, and Canadian physicians are poorly resourced to provide evidence-based management of their disease. Data from Canada are minimal, but research from the United States and Europe has shown that the incidence and lifetime risk of developing prostate cancer among Black people are more than double than among their white counterparts. ![]() Black patients present even more of a dilemma since evidence to guide practice in this group is lacking. Clinicians continue to grapple with the question of how to identify those with clinically important disease while avoiding overdiagnosis and overtreatment. 1, 2 The natural history of prostate cancer ranges from an indolent course to a fatal disease, which coincides with a spectrum of management strategies including active surveillance, surgery and radiation therapy. ![]() In 2022, it is estimated that prostate cancer will be diagnosed in more than 24 000 people in Canada, representing 20% of all new cancers in men. Prostate cancer represents the fourth most common cancer and the most common noncutaneous malignant disease among men in Canada. Implementing targeted screening programs in Canada for Black people could result in earlier detection and treatment, and lower risk of death.Īny attempt to alleviate racial disparities in health requires not just isolated changes such as screening and treatment guidelines, but also a wider understanding of systemic racism and its impacts on patient outcomes. Black people with prostate cancer face a complex interplay of structural barriers such as inadequate health education, underrepresentation in clinical trials and reduced access to treatment - all of which contribute to poor health outcomes.Ĭurrent screening guidelines do not provide specific guidance to clinicians treating Black patients, which likely contributes to their increased risk of developing and dying of prostate cancer. ![]()
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