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Deconstructing, Addressing, and Eliminating Racial and Ethnic Inequities in Prostate Cancer Care.

Yaw A Nyame1, Matthew R Cooperberg2, Marcus G Cumberbatch3

  • 1Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.

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Men of African ancestry face higher prostate cancer mortality globally. Addressing social and structural factors is key to reducing these racial disparities in care and outcomes.

Keywords:
Health servicesProstate cancerRacial disparitiesSocial determinants

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Area of Science:

  • Oncology
  • Health Disparities Research
  • Social Determinants of Health

Background:

  • Men of African ancestry exhibit disproportionately high prostate cancer mortality rates worldwide, particularly in the Caribbean, Sub-Saharan West Africa, and among African descendants in the USA.
  • Addressing these inequities requires a multifaceted research approach targeting structural, social, environmental, and health system factors.

Purpose of the Study:

  • To introduce a conceptual model for evaluating racial inequities in prostate cancer care.
  • To facilitate the development of translational research studies and interventions aimed at achieving equitable outcomes.

Main Methods:

  • A collaborative literature review was conducted on racial inequities in prostate cancer care and outcomes.
  • Existing literature was synthesized to inform the components of the conceptual model.

Main Results:

  • Racial inequities in prostate cancer outcomes are significantly influenced by structural and social determinants of health, affecting exposures, mediators, and health outcomes.
  • While incidence disparities persist, outcomes can be comparable when social and health factors, including access to equitable care, are normalized.
  • Few interventions have been tested to reduce prostate cancer inequities specifically among Black men.

Conclusions:

  • Prostate cancer outcomes for men of African ancestry are largely driven by social factors influencing biological, environmental, and healthcare risks.
  • A conceptual model was presented to organize factors influencing prostate cancer incidence and mortality, guiding the understanding of current inequities and the path toward equitable care.
  • Further research should focus on robustly characterizing the sources of these inequities to inform innovative interventions and trials for eradicating disparities.