Global prostate cancer disparities and the parts both genetic and behavioural factors play
Dr Folakemi Odedina - College of Pharmacy, University of Florida, Gainesville, USA
You’re the guest editor for a very important special issue in ecancer – can you tell us more?
The title of the special issue is ‘Looking at the global prostate cancer disparities in black men’. It is very important because when you look at the statistics what is obvious is that black men have the highest incidence of prostate cancer in the whole world and they are more likely to die from prostate cancer compared to any other racial or ethnic group. Starting from where we are in the United States, what we were previously doing was really comparing the white and the black differences but a more innovative way to look at it since black men are more genetically predisposed to get prostate cancer is to kind of take a look all over the world and look at all the black men all over the world. So this special issue really focuses on looking at firstly the science of prostate cancer in black men in North America, Europe, Africa and the Caribbean.
What are some of the topics covered?
The issue actually focusses on translational issues. So some of the topics take a look at the genetic risk factors for prostate cancer, others take a look at the behavioural risk factors for prostate cancer and some others take a look at the interventions that can be used to really address prostate cancer disparities. So what we try to do in the issue is to cut across the continuum of prostate cancer care and look at issues that really cover prevention, that cover diagnosis, that cover screening, treatment and survivorship and take a look at it, not only from the biological aspects but also take a look at it from the behavioural aspects as well.
What are some of the genetic mutations involved?
Prostate cancer is such a very complex disease. Unfortunately we really don’t understand it as much as the progress that has been made in breast cancer. What we know about prostate cancer is that there seems to be genetic predisposition that is linked to getting prostate cancer, especially among black men. Some of the things that have been discovered have to do with a genetic area of 8q24 that really is called, something that is found much more in black men of African ancestry, that is what we know. But what we also know is that although we do have black men really at risk for prostate cancer there are differences among those black men. So, for example, we tend to see more mortality from prostate cancer among Jamaicans and we tend to see a very high incidence of prostate cancer among US blacks. Meanwhile, Africans seem to have a lower incidence and lower mortality. So our goal is to really understand all the different groups and see whether they can learn from each other. If they are all genetically predisposed to get prostate cancer and they all have difference incidences and different mortalities then there might be something that we can learn from people from different regions and see how we can better address prostate cancer.
What about screening?
It’s such a big issue with the controversies on screening, one of the things that I think is very important to note that the screening studies that have been done really do not have a high number of black men for us to be able to make any prediction on whether screening is cost effective for blacks or not. The decisions that are being made are for the general population so until we are able to really find out how cost effective screening is in black men we really can’t make that jump, limiting screening. What we know is black men seem to be at a very high risk and so it becomes very important that that at risk group is able to have some informed decision about screening so that they can at least have a chance at early detection to be able to address it.
Do you think there’s a problem with awareness?
When we look at prostate cancer in black men in general there are so many complex things that there has to do with it. I think the disparity comes from different levels, especially in the United States. We have the individual level factors that have to do with awareness, knowledge, have to do with black men not really going to the doctor as often as they could or getting annual screening as much as they could. You also have the contextual healthcare system factors which have to do with access for these men. That’s a really big thing, especially for the ones that have low socioeconomic status. Then you have the provider clinical physician level factors that really they may not be taking the time to consult with the men and tell them what they need to do. Those are huge issues but the issues also are very different depending on the countries that you have. So you have very unique issues in the Caribbean as opposed to Africa where the healthcare system in Africa really cannot take that load of screening of them. So the issues are really diverse depending on which you country you are.
How did this special issue come about?
This special issue actually is the result of a meeting that happened in the Bahamas in 2012. Every two years we have a Science of Global Prostate Cancer Disparities in Black Men and that conference really, supported by the National Cancer Institute, brings together a group of men from Europe, from North America, from the Caribbean and now from Africa and it allows scientists and clinicians and advocates to really have a meeting of the minds and try to figure out where are we, what is the status of this disease in black me, what progress have we made and how can we move forward to make sure we have global impacts on prostate cancer in black men?
And the next meeting?
The next meeting is actually going to be in Jamaica and it’s going to be November 5th – 8th in Jamaica. And we purposefully selected Jamaica because the greatest mortality of prostate cancer is among Jamaicans. So we really hope that in addition to the progress that we are making in science that we will be able to make significant progress in Jamaica as well and raise awareness about prostate cancer in Jamaica and find a way to really deal with the disease and reduce the burden in Jamaican and other black men as well.