American cancer jersey new society

Abstract: Prostate cancer is a significant health problem for middle-aged and elderly men. In the United States (US), it is the most frequently diagnosed cancer and is the second leading cause of cancer death. While men of all racial and ethnic backgrounds are at risk, black men of African descent are at especially high risk. African-Caribbean men, particularly Jamaican men, have the highest rate of prostate cancer in the world. The term African-American has been used to describe all black people living in the US. Use of such broad categorization ignores the existence of subcultures within the black community. While members of the black race may share similar primary, genetic characteristics, skin color cannot be equated with attitudes, knowledge, and behaviors of particular cultural groups. Therefore, prostate cancer interventions developed for African-American men may not be effective for men of African-Caribbean descent.

Key Words: African Caribbean Men, Prostate Cancer

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Background and Significance

Prostate cancer is a significant health problem for middle-aged and elderly men. In the United States (US), it is the most frequently diagnosed cancer, accounting for 36% of all cancer cases (Office of Men's Health Resource Center, 2002) and is the second leading cause of cancer death (Brink, 2000). The incidence of prostate cancer is rare before the age of 55; however, rates increase appreciably with each succeeding decade of life so that up to 75% of all men have cancerous changes by age 75 (Federal Consumer Information Center, 2002). Early detection has been associated with favorable prognosis, but advanced disease can lead to metastasis to the bones and lungs. It has been estimated that 37,000 men in the US die from prostate cancer each year (Brink, 2000).

The cost of prostate cancer is great for both the individual and society. According to the American Cancer Society (ACS) (2000), the total annual cost of cancer in the US is $180.2 billion. This figure takes into account direct medical costs and indirect morbidity and mortality costs. Direct costs refer to all health expenditures including care provided by physicians and other health care professionals, cost of health care facilities, laboratory fees, and drugs. Over one-half of direct medical costs is associated with three cancers: breast, lung, and prostate. Prostate cancer costs a total of $5 billion each year. However, the dispersion of these dollars is highly dependent on the stage of the cancer at diagnosis. If prostate cancer is localized at the time of diagnosis, the annual cost of direct care ranges from $10,000 to $20,000 per patient. If, however, the disease is advanced at the time of diagnosis, the annual cost increases dramatically to $30,000 to $100,000 per patient (Grover, Zowall, Coupal, & Krahn, 1999).

Although not all prostate cancers are amenable to detection by simple screening, digital rectal examination (DRG) is an economical and minimally invasive test that can be highly sensitive when performed by a well-trained examiner. The sensitivity of the DRE can be enhanced by the addition of serum prostatic specific antigen (PSA) assessment. Due to the magnitude of costs, both human and financial, and the relative ease of screening, various national health care organizations, including the American Urological Association (AUA), the ACS, and the National Comprehensive Cancer Network have recommended that all males age 50 and over (age 45 for men at high risk) be provided with information regarding prostate cancer and offered annual prostate cancer screening (ACS, 2002a).

The cause of prostate cancer is unknown. While men of all racial and ethnic backgrounds are at risk, the disease burden is not equally shared leading to speculation of the possible causal links as being genetic, dietary, and socioeconomic factors. Asian men have the lowest incidence of prostate cancer (2/ 100,000) (Glover et al., 1998), but migration to the US produces a substantial increase in incidence rate. Black men living in West Africa have very low rates, but African-American men are exceedingly vulnerable for both morbidity and mortality (249/100,000) (Glover et al., 1998; Gregg, 1994). In the US, the incidence of prostate cancer approaches 200,000 cases each year; of these cases, it was estimated that between 30,000 and 40,000 deaths will be attributed to the disease (Brink, 2000; National Cancer Institute, 2002). Nationally, African-American men are diagnosed with prostate cancer up to 70% more frequently than are white men (ACS, 2002b); in the state of Florida, the incidence among African-American men is 66% higher than the rate for white men (Florida Prostate Cancer Task Force, 2000). Prostate cancer in African-American men is at more advanced stages at time of diagnosis, and they die from prostate cancer at more than twice the rate of any other group (ACS, 2002c; Brink, 2000; Centers for Disease Control (CDC), 2002; Maloney, 1999; National Cancer Institute, 2002; New Jersey Department of Health and Senior Services, 2000). In 1998 in Florida, the mortality rate for prostate cancer in black men was 190% higher than in white men (Florida Prostate Cancer Task Force, 2000).

The morbidity and mortality of prostate cancer in black men in the US is clearly alarming. Accordingly, much emphasis has been focused on improving detection and treatment for this minority group (Boyd, Weinrich, Weinrich, & Norton, 2001; Florida Prostate Cancer Task Force, 2000; Moul, 2000; Shelton, Weinrich, & Reynolds, 1999; Stallings et al., 2000; US Department of Health and Human Services, 2000; Weinrich, Reynolds, Tingen, & Starr, 2000).

African-Caribbean men, particularly Jamaican men, have the highest rate of prostate cancer in the world (304/100,000) (Glover et al., 1998). Due to the prevalence of infectious diseases, the life expectancy for men living in Haiti is only 49.7 years, with only 8.4% of the men expected to live past 60 years (World Health Organization, 2001a). For men of African descent, the age-specific risk for prostate cancer increases at age 45 years (ACS, 2001; AUA, 2001). Therefore, few men living in Haiti survive into the years associated with increased risk, and the incidence rate of prostate cancer among black men living in Haiti is unknown. However, relocating from Haiti to the US extends the life expectancy of Haitian men by 19 years (World Health Organization, 2001b), thereby giving Haitian-born men living in the US the opportunity to experience age-related prostate changes.

Theoretical Framework

Purnell's Model for Cultural Competence (Purnell & Paulanka, 2003) was constructed specifically to assist "health-care providers ... to provide holistic, culturally competent, therapeutic interventions, health promotion, health maintenance, disease prevention, and health teaching" (p. 8). Listed among the purposes of the model are to: (a) provide a framework for all health-care providers to learn inherent concepts and characteristics of cultures, (b) interrelate characteristics of culture to promote congruence and facilitate the delivery of consciously competent care, and (c) provide a framework that reflects human characteristics such as motivation, intentionality, and meaning. Accordingly, analysis of cultural data provides the foundation for the adoption, modification, or rejection of health-care treatment regimens according to the needs of the individual and the impact on the quality of the individual's health-care experiences and personal existence.

The term "African-American" has been broadly used to describe all black people living in the US. Use of such sweeping categorization pays little regard to the existence of subcultures within the black community at large. There is much diversity within this broad population, and there are specific attributes of ethnicity that exceed limitations of the definition of race. While members of the black race may share similar primary, genetic characteristics, skin color cannot be equated with behavior. Purnell and Paulanka (2003) pointed out that members of subcultures, composed of immigrants may maintain identifiable secondary characteristics that influence how they view the world and behave in it. Pertinent among the secondary characteristics are socioeconomic status, length of time away from the country of origin, education, reason for immigration, and legality of immigration status.