African-American men understimate risk of prostate cancer

Many African-American men radically underestimate the likelihood that having a needle biopsy for suspected prostate cancer will result in a cancer diagnosis, according to a study from the University of Chicago Medical Center.

The researchers, who presented their results at the American Society of Clinical Oncology annual meeting in Chicago, say this is alarming. African-American men have a higher incidence rate, are diagnosed later, and have a higher mortality rate from prostate cancer than Caucasians.

"A group that underestimates the risk of having cancer is likely to underestimate the value of early detection and thus skip the whole process," said study author William Dale, MD, PhD, assistant professor of medicine/geriatrics at the University of Chicago, "which may explain, in part, why African-American men are so often diagnosed later and thus have worse outcomes."

Dale and colleagues collected data on what 243 patients expected from their biopsies and their anxiety levels while waiting in a urology clinic. The average age of these patients was 63. Almost 40 percent of the men were African-American. Fifty-six percent had at least a college education level.

Despite being referred for biopsy because they were known to be at increased risk for prostate cancer, usually due to a blood test, 55 percent of the African-American men at the time of prostate biopsy said they had a zero percent chance of having prostate cancer (i.e. that it was impossible). Only 20 percent of the Caucasian men said this.

Of the African-American men in the clinics whose biopsy results were available to the researchers, 70 percent were subsequently diagnosed with prostate cancer (compared with 50 percent of the Caucasians). Those who had more anxiety about prostate cancer were less likely to have cancer than those who were less worried.

In general, although African Americans were less likely to believe they were at risk for cancer and less anxious about possibly having cancer, they were actually more likely to have prostate cancer.

"These data suggest that, while men of both races underestimate their chances of having prostate cancer, African American men are even more likely to do so. Such beliefs may cause these men at highest risk for prostate cancer to delay the pursuit of a diagnosis," says Dale.

"With this data, we can't say why the estimates are so low. We want to conduct more research to better understand the reasons for the overly low estimates," says Dale. "That would hopefully lead to greater attention to prostate cancer for those at highest risk such as African Americans."