Factors and Psychosocial Barriers affecting Engagement of African American Men in Prostate Cancer Care and Prevention and Strategies for Intervention Chinedum Muo Abstract Prostate cancer, the second-leading cause of cancerrelated deaths in U.S. men, is evidenced most in African American men at alarming rates. Despite the past decade witnessing a decrease in both incidence and mortality rates, and an increase in five-year survival rates for African American men afflicted with prostate cancer, it continues to disproportionately affect this population when compared to other ethnic groups. Several factors may contribute to the disparity. A systematic examination of the literature was performed to evaluate and understand how factors, attitudes and behaviors concerning prostate cancer-related healthcare influence the engagement of African American men in preventive care and/or treatment options. Access to health screenings for earlier detection, health literacy in prostate cancer, and deprived patient-provider communication proved to be obstacles to engagement. Community education, interventions involving community leaders, family members, and prostate cancer survivors, as well as open, informed decision making between providers and their patients should be considered in the attempt to alleviate this disparity. Keywords: Healthcare Disparities, Prostatic Neoplasms,
African Americans, Minority Health, Prevention & Control, Ethnopsychology, Cultural Competency
Introduction Prostate cancer, the most commonly diagnosed form of cancer among men in the U.S.1, is a result of the abnormal and uncontrolled growth of cells in the prostate gland, the walnut-sized male reproductive gland responsible for the production of prostatic fluid. Major risk factors for prostate cancer include age, race, and family history. Prostate cancer presents at an earlier age in African American men among all ethnic groups, putting them at higher risk for the disease in addition to experiencing a greater likelihood of metastasis at the time of diagnosis.1,5 When controlling
for such factors as socioeconomic status, African American men have been found to still be at a greater risk of developing the disease than any other ethnic group in the U.S.6 Shared factors for increased risk of prostate cancer among all men include older age, with 75% of prostate cancers being associated with men age 60 and over7, and a family history of prostate cancer with an emphasis on immediate first-degree relatives including fathers and brothers that have been diagnosed with the disease.7 Other probable risk factors for prostate cancer include diet and physical activity. Diets high in red meat or high-fat dairy products may increase prostate cancer risk.8 Studies reveal that African American men consume more red meat and fast food on average than White men.9 Physical activity may help to decrease risk of prostate cancer by 10-30%.10 Additionally, inactive men are shown to have higher rates of prostate cancer diagnosis compared to physically active men. In 2016, the American Cancer Society (ACS) estimated 180,890 new cases of prostate cancer emerging in the U.S.1 Of that number, an estimated 26,190 men would die from prostate cancer, making it the second-leading cancer-related cause of death among men after lung cancer, the leading cause of cancer deaths in both men and women. The risk of prostate cancer for African American men is 70% higher than in non-Hispanic White men in the U.S.1 In 2013, 35,430 African American men were expected to be diagnosed with prostate cancer alone, making them 1.6 times more likely to be diagnosed with prostate cancer and 2.4 times more likely to die from it than White men.4,5 Despite the past decade in which both incidence and mortality rates have gone down and five-year survival rates have gone up for African American men afflicted with prostate cancer, it continues to disproportionately affect African American men when compared to other ethnic groups in the U.S. The figures are alarming and the underlying reason
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