Abstract B91: Race and prostate cancer screening: Nashville men's preventive health survey

Background: Prostate cancer is the most common type of cancer found among men in the U.S., besides skin cancer, with a disproportionate impact on African American men. Many older men with prostate cancer have relatively good chances of surviving this cancer, especially when it is detected early. However, only about half of men age 50 and older are screened for prostate cancer each year. This paper examines the knowledge, attitudes and behaviors held by white and African American men that influence whether or not they visit a doctor, talk about screening options and are screened for prostate cancer.

Methodology: The Nashville Men's Preventive Health Survey was collected in 2007 using a community-based participatory research (CBPR) approach, with guidance from a Community Steering Committee. A multistage random sample that is stratified and clustered was drawn of Census blocks in Nashville/Davidson County, Tennessee. In the selected Census blocks, all households were sampled, and all non-Hispanic white and African American (AA) men ages 40–70 years old with no history of prostate cancer were invited to participate in the survey, yielding a sample of approximately 400 men. The sample consists of roughly half white men and half African American men. Descriptive analyses adjust for complex sampling design and multivariate analyses use multilevel regression models.

Results: Around 40% of men were not currently employed, around 18% reported having no health insurance. Slightly over half of men reported being screened for prostate cancer in the past 12 months (either PSA blood test or digital rectal exam (DRE)), with no significant difference by race. However, AA men were more likely to report that they have talked with their doctor about prostate cancer screening options, and that they plan to get screened in the next 12 months. Among men who have never been screened, more AA men expressed interest in talking with their doctor about screening options. White men were more likely to be able to name correctly the two ways to screen for prostate cancer. While overall prostate cancer knowledge did not differ by race, AA men were less likely to know where the prostate gland is located in the body and that early stages of prostate cancer usually cause no pain. At the same time, AA men were more likely to know that AA men are more likely to die from prostate cancer than white men once diagnosed. Among men who were ever screened, the reasons for getting screened did not differ substantially by race, although AA men cited doctor recommendation less often and spiritual beliefs more often than white men. On the other hand, reasons for not having been screened differed notably by race; AA men cited fatalistic reasons more often (trust in God and no benefit of early detection) and a perception that most men their age do not get screened. Four out of five men indicated that they would like to see more attention to men's health issues in the media, with a higher percentage for AA men.

Conclusions: The survey findings will be used to improve or design new community outreach programs that help men overcome the barriers to informed decision-making and prostate cancer screening. The potential long-term impacts are a reduction in mortality from prostate cancer and a reduction in racial disparities in prostate cancer outcomes, due to earlier detection.