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Equal-Access Health-Care System for African American and White Men With Prostate Cancer


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Among men with prostate cancer who received care from the U.S. Department of Veterans Affairs (VA) Health System, an equal-access health-care system, African American men did not have more advanced disease at the time of diagnosis or die earlier than white men, unlike trends seen in the greater U.S. population of patients with prostate cancer. These findings were published by Riviere et al in Cancer.

Cohort Population

African American men in the general U.S. population are more than twice as likely to die from prostate cancer as non-Hispanic white men. To examine whether access to health care may play a role in this disparity, a team led by Brent Rose, MD, of the University of California, San Diego School of Medicine and the VA San Diego Healthcare System, analyzed information on more than 20 million veterans who receive care through the VA Health System. The analysis included a cohort 60,035 men diagnosed with prostate cancer between 2000 and 2015: 30.3% were African American and 69.7% were non-Hispanic white.


“These results suggest that poorer outcomes for African American men with prostate cancer may not be a foregone conclusion. With smart public policy choices, we may be able to reduce or even eliminate disparities and achieve equal outcomes for all men with prostate cancer."
— Brent Rose, MD

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Analysis

At the time of diagnosis, African American men tended to be younger (median age = 63 years vs 66 years for non-Hispanic white men) and had a higher prostate-specific antigen level; however, they were less likely to have Gleason score 8–10 disease, a clinical T classification ≥ 3, or distant metastatic disease. The researchers found that in the VA system, African American men were not more likely to experience delays in diagnosis and care; were not more likely to present with more advanced disease; and were not more likely to die from their disease. These outcomes for African American men were seen even though they were more likely to live areas with a lower median income and a lower high school graduation rate.

The 10-year prostate cancer–specific mortality rate was lower for African American men (4.4% vs 5.1% for non-Hispanic white men, P = .005), which was confirmed in multivariable competing-risk analysis.

The findings indicate that African American men who receive equitable screening and treatment can expect to have relatively similar outcomes to non-Hispanic white men. Access to high-quality medical care may help address some of the racial disparities seen among men diagnosed with the disease.

“These results suggest that poorer outcomes for African American men with prostate cancer may not be a foregone conclusion. With smart public policy choices, we may be able to reduce or even eliminate disparities and achieve equal outcomes for all men with prostate cancer,” said Dr. Rose.

Disclosure: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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