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Nyame YA, Cooperberg MR, Cumberbatch MG, Eggener SE, Etzioni R, Gomez SL, Haiman C, Huang F, Lee CT, Litwin MS, Lyratzopoulos G, Mohler JL, Murphy AB, Pettaway C, Powell IJ, Sasieni P, Schaeffer EM, Shariat SF, Gore JL. Deconstructing, Addressing, and Eliminating Racial and Ethnic Inequities in Prostate Cancer Care. Eur Urol 2022; 82:341-351. [PMID: 35367082 DOI: 10.1016/j.eururo.2022.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Men of African ancestry have demonstrated markedly higher rates of prostate cancer mortality than men of other races and ethnicities around the world. In fact, the highest rates of prostate cancer mortality worldwide are found in the Caribbean and Sub-Saharan West Africa, and among men of African descent in the USA. Addressing this inequity in prostate cancer care and outcomes requires a focused research approach that creates durable solutions to address the structural, social, environmental, and health factors that create racial disparities in care and outcomes. OBJECTIVE To introduce a conceptual model for evaluating racial inequities in prostate cancer care to facilitate the development of translational research studies and interventions. EVIDENCE ACQUISITION A collaborative review of literature relevant to racial inequities in prostate cancer care and outcomes was performed. Existing literature was used to highlight various components of the conceptual model to inform future research and interventions toward equitable care and outcomes. EVIDENCE SYNTHESIS Racial inequities in prostate cancer outcomes are driven by a series of structural and social determinants of health that impact exposures, mediators, and outcomes. Social determinants of equity, such as laws/policies, economic systems, and structural racism, affect the inequitable access to environmental and neighborhood exposures, in addition to health care access. Although the incidence disparity remains problematic, various studies have demonstrated parity in outcomes when social and health factors, such as access to equitable care, are normalized. Few studies have tested interventions to reduce inequities in prostate cancer among Black men. CONCLUSIONS Worldwide, men of African ancestry demonstrate worse outcomes in prostate cancer, a phenomenon driven largely by social factors that inform biologic, environmental, and health care risks. A conceptual model was presented that organizes the many factors that influence prostate cancer incidence and mortality. Within that framework, we must understand the current state of inequities in clinical prostate cancer practice, the optimal state of what equitable practice would be, and how achieving equity in prostate cancer care balances costs, benefits, and harms. More robust characterization of the sources of prostate cancer inequities should inform testing of ambitious and innovative interventions as we work toward equity in care and outcomes. PATIENT SUMMARY Men of African ancestry demonstrate the highest rates of prostate cancer mortality, which may be reduced through social interventions. We present a framework for formalizing the identification of the drivers of prostate cancer inequities to facilitate the development of interventions and trials to eradicate them.
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Affiliation(s)
- Yaw A Nyame
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco, CA, USA
| | | | - Scott E Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Christopher Haiman
- Department of Preventive Medicine, Center for Genetic Epidemiology, University of Southern California, Los Angeles, CA, USA
| | - Franklin Huang
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Cheryl T Lee
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Mark S Litwin
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes, Institute of Epidemiology & Health Care, University College London, London, UK
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Adam B Murphy
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Curtis Pettaway
- Department of Urology, M.D. Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Isaac J Powell
- Department of Urology, Wayne State University, Detroit, MI, USA
| | - Peter Sasieni
- Cancer Research UK & King's College London Cancer Prevention Trials Unit, King's College London, London, UK
| | - Edward M Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - John L Gore
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Fattahi Ardakani M, Salehi-Abargouei A, Sotoudeh A, Esmaeildokht S, Bahrevar V. Do Subjective Norms Predict the Screening of Cancer Patients' First-Degree Relatives? A Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev 2020; 21:1521-1530. [PMID: 32592344 PMCID: PMC7568886 DOI: 10.31557/apjcp.2020.21.6.1521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Early detection and preventive measures can reduce the risk of cancer among first degree relatives (FDRs) of cancer patients.Several studies investigated the effect of subjective norm in relation to FDRs' tendency to conduct preventive behaviors. Therefore, the purpose of this study was to systematically evaluate the effect of subjective norms on cancer patients' FDRs as well as their willingness for screening. METHODS PubMed and Scopus were studied to investigate the effect of subjective norms on preventive measures such as breast cancer self-examination, colonoscopy, PSA testing, skin examination, and genetic testing. Odds Ratio (OR), correlation was and confidence intervals were extracted for meta-analysis. After reviewing the studies, only 16 studies met the criteria to be included in this systematic review. RESULTS The meta- analysis and OR showed that Physician Recommendation (OR=6.98, 95% CI; 2.55-19.09, P<0.001), Health Care Provider (HCP) (OR=2.79, 95% CI; 1.26-6.16; P=0.011), family and friends (OR=1.82, 95% CI; 1.33-2.50, P <0.001) significantly enhanced the likelihood of referring for screening and preventive measures. CONCLUSIONS The results of the current study indicated that subjective norms can significantly increase willingness to screening.
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Affiliation(s)
| | - Amin Salehi-Abargouei
- Nutrition Department, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ahmad Sotoudeh
- Department of Public Health, School of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Vali Bahrevar
- Department of Health Eduacation, Faculty of public health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Prostate cancer disparities in Hispanics by country of origin: a nationwide population-based analysis. Prostate Cancer Prostatic Dis 2018; 22:159-167. [DOI: 10.1038/s41391-018-0097-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 11/09/2022]
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Magin P, Tapley A, Davey A, Morgan S, Henderson K, Holliday E, Ball J, Catzikiris N, Mulquiney K, Spike N, Kerr R, van Driel M. Prevalence and associations of general practitioners' ordering of "non-symptomatic" prostate-specific antigen tests: A cross-sectional analysis. Int J Clin Pract 2017; 71. [PMID: 28869684 DOI: 10.1111/ijcp.12998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/03/2017] [Indexed: 11/29/2022] Open
Abstract
AIMS Testing for asymptomatic prostate cancer with prostate specific antigen (PSA) is of uncertain benefit. Most relevant authorities recommend against screening, and for informed patient choice. We aimed to establish the prevalence and associations of "non-symptomatic" PSA-testing of men aged 40 or older by early-career general practitioners (GP registrars). METHODS A cross-sectional analysis from the ReCEnT cohort study of registrars' consultations, 2010-2014 (analysed in 2016). Registrars record 60 consecutive consultations each 6-month training term. The outcome factor was ordering an "asymptomatic" PSA test (a PSA ordered for an indication that was not prostate-related symptoms or prostatic disease monitoring). Independent variables were patient, registrar, practice, consultation and educational factors. RESULTS A total of 856 registrars contributed details of 21,372 individual consultations and 35,696 problems/diagnoses of males 40 or older. Asymptomatic PSAs were ordered for 1.8% (95%CI: 1.7-2.0%) of consultations and for 1.1% (95%CI: 1.0-1.2%) of problems/diagnoses. Multivariable associations of asymptomatic PSA testing (compared with problems/diagnoses for which a PSA was not ordered) included patient age (OR 2.32 [95%CI: 1.53-3.53] for 60-69 years compared with 40-49), patient ethnicity (OR 0.40 [95%CI: 0.19-0.86] for non-English speaking background), the patient being new to both the registrar and practice (ORs 1.46 [95%CI: 1.08-1.99] and 1.79 [95%CI: 1.03-3.10]), the number of problems/diagnoses addressed (OR 1.44 [95%CI: 1.25-1.66] for each extra problem) and more pathology tests being ordered (OR 1.88 [95%CI: 1.79-1.97] for each extra test). CONCLUSION GP registrars frequently order "asymptomatic" PSA tests. Our findings suggest that non-compliance with current guidelines for PSA screening may be relatively common and that targeted education is warranted.
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Affiliation(s)
- Parker Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
| | - Simon Morgan
- Elermore Vale General Practice, Elermore Vale, New South Wales, Australia
| | - Kim Henderson
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Jean Ball
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Nigel Catzikiris
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
| | - Katie Mulquiney
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
| | - Neil Spike
- Eastern Victoria GP Training, Hawthorn, Victoria, Australia
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Rohan Kerr
- General Practice Training Tasmania, Hobart, Tasmania, Australia
| | - Mieke van Driel
- School of Medicine, Royal Brisbane & Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
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Harmon BE, Little MA, Woekel ED, Ettienne R, Long CR, Wilkens LR, Le Marchand L, Henderson BE, Kolonel LN, Maskarinec G. Ethnic differences and predictors of colonoscopy, prostate-specific antigen, and mammography screening participation in the multiethnic cohort. Cancer Epidemiol 2014; 38:162-7. [PMID: 24667037 PMCID: PMC4325992 DOI: 10.1016/j.canep.2014.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Given the relation between screening and improved cancer outcomes and the persistence of ethnic disparities in cancer mortality, we explored ethnic differences in colonoscopy, prostate-specific antigen (PSA), and mammography screening in the Multiethnic Cohort Study. METHODS Logistic regression was applied to examine the influence of ethnicity as well as demographics, lifestyle factors, comorbidities, family history of cancer, and previous screening history on self-reported screening participation collected in 1999-2002. RESULTS The analysis included 140,398 participants who identified as white, African American, Native Hawaiian, Japanese American, US born-Latino, or Mexican born-Latino. The screening prevalences overall were mammography: 88% of women, PSA: 45% of men, and colonoscopy: 35% of men and women. All minority groups reported 10-40% lower screening utilization than whites, but Mexican-born Latinos and Native Hawaiian were lowest. Men were nearly twice as likely to have a colonoscopy (OR=1.94, 95% CI=1.89-1.99) as women. A personal screening history, presence of comorbidities, and family history of cancer predicted higher screening utilization across modalities, but to different degrees across ethnic groups. CONCLUSIONS This study confirms previously reported sex differences in colorectal cancer screening and ethnic disparities in screening participation. The findings suggest it may be useful to include personal screening history and family history of cancer into counseling patients about screening participation.
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Affiliation(s)
- Brook E Harmon
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA.
| | - Melissa A Little
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Erica D Woekel
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Reynolette Ettienne
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Camonia R Long
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Lynne R Wilkens
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Loic Le Marchand
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Brian E Henderson
- University of Southern California, Health Sciences Campus, NRT Lg 1502, Los Angeles, CA 90089, USA
| | - Laurence N Kolonel
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Gertraud Maskarinec
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
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Cooperman JL, Efuni E, Villagra C, DuHamel K, Jandorf L. Colorectal cancer screening brochure for Latinos: focus group evaluation. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:582-590. [PMID: 23821134 PMCID: PMC3775318 DOI: 10.1007/s13187-013-0506-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Colorectal cancer (CRC) can be effectively prevented via screening colonoscopy, yet adherence rates remain low among Latinos. Interventions targeting individual and cultural barriers to screening are needed. We developed an educational brochure to target these barriers faced by a diverse Latino population. The objective was to evaluate the responses of the target population to the culturally and theoretically informed brochure through community member focus groups. Facilitators conducted six focus groups, stratified by gender, language, and prior colonoscopy experience. Topics included: brochure content and layout, cancer knowledge, and CRC screening determinants. Focus groups documented community members' responses to the brochure's overall message and its informational and visual components. Changes to wording, visual aids, and content were suggested to make the brochure culturally more acceptable. Results indicated relevance of the theoretically and culturally guided approach to the development of the brochure leading to refinement of its content and design.
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Affiliation(s)
- Julia L Cooperman
- Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029, USA.
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