Dr. Durado Brooks urges men to consider all the options when it comes to getting screened for prostate cancer.

An informed business professional usually tries to weigh pros and cons before making a decision, and the American Cancer Society advises that men do the same when it comes to prostate cancer screening. The disease is the most diagnosed deadly cancer for all men, but the death rate from prostate cancer for black men is two times higher than that of white men, and the highest among all races.

• SEE ALSO: Diligence in Detection

Although African Americans should consider this information when deciding whether to screen for this cancer, the choice is not cut-and-dried.  Dr. Durado Brooks, director of prostate and colorectal cancers at the American Cancer Society, talked with the Wellness Insider to offer some insight in light of the organization’s update of its early detection guidelines.

Prostate screening isn’t for everyone and it isn’t perfect. One European study, published in 2009, showed that the PSA (prostate-specific antigen) blood test may save lives but there is conflicting research. “PSA tests are not right for every man though they’ve long been promoted that way,” says Brooks. “The decision to screen for cancer should be made based on [a man's] preferences and values. Some men want to know anything and everything wrong with their bodies, so the PSA may be good for them.”

Not all prostate cancers need to be treated. “The idea of having cancer and not treating it creates cognitive dissonance. It’s hard for people to wrap their heads around,” Brooks says.  Because of our impression of cancer, patients – and sometimes their doctors – are reluctant to leave it untreated, he says. A man with no symptoms who is of advanced age (who has a life expectancy of less than 10 more years) or who has a life-shortening medical condition should not be screened.  Treating the disease could be more of a health threat than leaving it alone.

There is an alternative to surgery or chemotherapy. Although some newly diagnosed cases are advanced to a point where they clearly warrant treatment, “in many cases it’s not clear whether the cancer will be aggressive or slow-growing,” Brooks says.  “Active surveillance has grown in the U.S., but it’s still used relatively infrequently.”  In active surveillance, physicians keep watch on the cancer to gauge its progress.  Men who are in fragile health or who don’t want to live with the side effects of treatment might choose this alternative. When it comes to prostate cancer, the picture is blurry, Brooks says. Nevertheless, “I’m confident that over the next decade, we will have some answers.”

For more information:
Prostate Cancer: Early Detection
Testing for Prostate Cancer
Prostate Cancer Screening: A Decision Guide for African Americans

The latest edition of “Cancer Facts & Figures for African Americans 2009-2010” found that a rapid reduction in death rates from lung and prostate cancers is the primary reason that death rates declined for all cancers combined among African American men.

Lung cancer is the leading cause of cancer-related deaths among African American men and women.

The report has been released every two years for the past 18 years and identifies disparities between blacks and whites in terms of rates for death, cancer occurrences, and screenings.

There is proof that cervical, breast, and colon cancer screenings work to prevent diseases, but prostate cancer screening is not proven, says Dr. Otis W. Brawley, an ACS spokesperson.

“We hope that prostate cancer screenings save lives, but we have no studies [which show that they do]. We have a theory,” Brawley says. “The difference is we know colorectal screening saves lives. There is no question about it. We have this amazing problem that 20% to 30% of black men are getting colon cancer screening while 70% are getting prostate cancer screening. Doctors don’t push colorectal screening the way they should.”

The report also shows that while overall cancer death rates have declined among African American women, they are falling at a slower rate than among white women.

“Part of the black/white difference in cancer rates is the black/white difference in obesity,” he says. “The most important thing that we can advise blacks in terms of diet and physical activity is that they need to eat five to nine servings of fruits and vegetables a day, and they need to get physically active and try to maintain an ideal body weight.”

Unfortunately, Brawley predicts that cancer death rates are going to level out in the future and that rates just might start increasing because screening rates have decreased.

“Race does not matter accept in the socioeconomic sense,” says Brawley, emphasizing the importance of cancer screenings to save lives. “The data shows equal screening and treatment produces equal outcome.”

The racial gap in colorectal, or colon, cancer death rates is widening, according to new findings, even as fewer Americans are dying from the disease.

Lack of access to quality healthcare and getting proper screenings is being attributed to blacks’ lower screening rates, according to the American Cancer Society, which released a new report, “Colorectal Cancer Facts and Figures 2008-2010,” on the state of the disease.

The report of lower rates overall “is a good news-bad news situation,” says Dr. Durado Brooks, the American Cancer Society’s director of colorectal and prostate cancers. “Over the last decade we’ve seen a steady decline in the portion of the population who is getting colorectal cancer and dying from the disease. The bad news is that because rates are declining so rapidly in the white population, the gap for African Americans with colorectal cancer is wider now. The rates have been falling more quickly with whites, and it has now led to a huge, and frankly, disturbing likelihood of dying from the disease.”

Colorectal cancer is one that develops in the colon or the rectum. The cancer usually develops slowly over a period of many years. Before a true cancer develops, it usually begins as a noncancerous polyp, which may eventually become cancer.

Among African Americans, incidence rates are more than 20% higher and mortality rates are about 45% higher than those in whites, according to the report. However, prior to 1989, rates were predominantly higher in white men than in African American men and were similar for women of both races. The gap in mortality has widened over time so that in 2005, rates were about 48% higher in African American men and women than in whites.

Only half of people age 50 or older, for whom screening is recommended, have received the recommended tests. If you have a family history of the disease, you should start screening earlier.

Colorectal screening is crucial in both decreasing the likelihood of developing the disease and decreasing the mortality rate. “When we do screening, we are actually looking for noncancerous polyps,” says Brooks. “By finding and removing polyps, we can remove them and stop them from occurring.”

The most common kind of test is a colonoscopy, in which the doctor looks at the entire length of the colon and rectum with a colonoscope. A lower-cost alternative is a stool test, which the ACS recommends be done every year.

Among African Americans, the five-year relative survival rate for colon cancer is 30% higher among patients who are privately insured compared to those without health insurance.

One study found that among those at high risk for colon cancer, African Americans were half as likely as whites to get colonoscopy screening, even after accounting for differences in education, income, and health insurance status. In this case, the most common reason given for not being tested, both by African Americans and whites, was the lack of a physician’s recommendation.

Several studies have documented that African American patients are more likely to be diagnosed after the disease has spread beyond the colon. In addition, African Americans with colorectal cancer are less likely than white patients to receive recommended treatment.

Part of screening gap is the access to care issue. African Americans and other minorities are more likely to be uninsured and not have access to adequate and regular healthcare, and those of the people who aren’t being screened at higher levels, says Brooks. The ACS and the National Medical Association, a medical association representing the interests of African-American physicians and their patients, are working together to reduce cancer disparities.

Studies have also shown that insurance status can play a key role in survival, according to the ACS. Racial and ethnic minorities tend to receive lower quality healthcare than whites even when insurance status, income, age, and severity of conditions are comparable, according to a 2007 ACS report.

For example, among African Americans, the five-year relative survival rate for colon cancer is 30% higher among patients who are privately insured compared to those without health insurance.

While screening is an important step in lowering the rates of colorectal cancer, the type and quality of care once diagnosed also has a lot to do with successfully fighting the disease. If you are found to have the disease at a more advanced stage and are treated with less than optimal care, then the survival rates are lower, says Brooks. If colon cancer is found in its earlier stage, nine out of 10 people who are treated will be alive five years later. That’s compared with one out of 10 for those who are treated after it has spread.

Colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of death in both men and women in the U.S. About 148,810 people will be diagnosed with colorectal cancer in 2008, and about 49,960 people will die from the disease this year.

Recommendations for the Prevention of Colorectal Cancer

Screening tests that detect and remove polyps are the most reliable method of preventing colorectal cancer. Other approaches to reduce risk are specified in the current American Cancer Society recommendations for nutrition and physical activity.

-Get screened regularly.

-Maintain a healthy weight.

-Adopt a physically active lifestyle.

-Consume a healthy diet with an emphasis on plant sources.

-Choose foods and beverages in amounts that help achieve and maintain a healthy weight.

-Eat 5 or more servings of a variety of vegetables and fruits each day.

-Choose whole grains in preference to processed (refined) grains.

-Limit your consumption of processed and red meats.

-Limit alcohol consumption.

(Source: American Cancer Society)

Further Reading

Can Colorectal Polyps and Cancer Be Found Early?

Cancer Prevention & Early Detection

Can Colorectal Cancer Be Prevented?