Prostate cancer screening in Black men in Canada: a case for risk-stratified care.

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Date: Oct. 24, 2022
From: CMAJ: Canadian Medical Association Journal(Vol. 194, Issue 41)
Publisher: CMA Impact Inc.
Document Type: Report
Length: 4,387 words
Lexile Measure: 2270L

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Prostate cancer represents the fourth most common cancer and the most common noncutaneous malignant disease among men in Canada. In 2022, it is estimated that prostate cancer will be diagnosed in more than 24 000 people in Canada, representing 20% of all new cancers in men. (1,2) The natural history of prostate cancer ranges from an indolent course to a fatal disease, which coincides with a spectrum of management strategies including active surveillance, surgery and radiation therapy. Clinicians continue to grapple with the question of how to identify those with clinically important disease while avoiding overdiagnosis and overtreatment. Black patients present even more of a dilemma since evidence to guide practice in this group is lacking. Data from Canada are minimal, but research from the United States and Europe has shown that the incidence and lifetime risk of developing prostate cancer among Black people are more than double than among their white counterparts. (3,4) Current guidelines for prostate cancer have very limited generalizability to Black patients, and Canadian physicians are poorly resourced to provide evidence-based management of their disease. We discuss the current state of evidence and guidance for prostate cancer screening among Black patients in Canada and consider whether guidelines should be re-evaluated to consider differential screening for this high-risk population group.

How are Black people disproportionately affected by prostate cancer?

Mortality and incidence rates of prostate cancer vary widely worldwide by region and source, reflecting variance in screening guidelines and health care resources, as well as ethnocultural differences. (5-12) In the Caribbean, prostate cancer incidence rates as high as 304 per 100000 men have been documented, (5-7) compared with 4.7-19.8 per 100 000 in West Africa, 11.5 per 100 000 in Asia, -113.6 per 100 000 in Canada and 111.3 per 100 000 in the US. (8-10) A 2020 publication that estimated global cancer burden found the highest mortality rate for prostate cancer in the Caribbean (27.9 per 100 000), followed by Middle, Southern and Western Africa (24.8, 22.0 and 20.2 per 100 000, respectively), and Micronesia and Polynesia (18.8 per 100 000). (12)

Some studies have evaluated epidemiological data for prostate cancer by racial groups in the same region. In England, the incidence rate of prostate cancer was more than twice as high among Black people (rate ratio 2.1) than among white people in 2013-2017. (13) In 2008-2010, the lifetime risk of a Black man in England dying from prostate cancer was 8%, compared with 4% for a white man and 2% for an Asian man. (4) In the US, African American men are more likely to receive a diagnosis of prostate cancer at an advanced stage and twice as likely to die from prostate cancer than white men. (10) The consistently high mortality rates for Black people across many regions may bolster the argument for genetic predisposition. (8) However, environmental and social factors clearly play an important role. Notably, incidence rates of prostate cancer are up to 40 times greater among African American men than men...

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Gale Document Number: GALE|A723284558