WASHINGTON--Recognizing the devastating burden of prostate cancer, particularly among black men, the American Cancer Society (ACS) has released a plan of action aimed at addressing issues in research, education, patient and family support, and public policy. ACS president-elect Charles J. McDonald, MD, said that the Society will convene a conference shortly of "all key African-American national organizations" to determine how to implement the plan.
"Prostate cancer, particularly among African-Americans, is a disgraceful tragedy that needs a holistic approach to knowledge, awareness, and advocacy," said John R. Kelly, PhD, vice chairman of the ACS board of directors. "This proposal of actions is the beginning of just such an approach."
Prostate cancer is the most common cancer in American males, with the incidence for black men approaching twice that of white men (234 per 100,000 versus 135 per 100,000). An estimated 184,500 new cases will be diagnosed in 1998, and 39,200 men will die from the disease.
The ACS recently made prostate cancer one of its high cancer-control priorities. It has earmarked 10% of its budget, about $10 million, for prostate cancer research in three broad areas: cell biology, health policy and outcomes, and behavioral, psychosocial, and quality of life.
At a press conference announcing the Societys "National Blueprint for Action," Dr. McDonald, professor of medical science, Brown University, called our knowledge of prostate cancer "woefully limited." He recited a list of unknowns:
- Why black men are far more likely than white men to develop the disease and why they are two to three times more likely to die of it.
- How to substantially reduce the risk of developing the disease.
- Whether early detection of the cancer through screening actually saves lives.
- Which aggressive treatments are the most effective.
- How to identify insignificant prostate cancers for which treatment can be avoided or delayed.
- How best to inform African-Americans about the disease and about the technologies and services available to them.
Five Challenging Areas
The action plan emerged from a conference in Houston last year, sponsored by the ACS, the National Cancer Institute, and the Centers for Disease Control and Prevention. The meeting brought together more than 260 researchers, clinicians, and representatives of patient-support and national black organizations.
The recommendations from the meeting revolve around "five critical chal-lenges," Dr. McDonald said. Within these five general areas (see below), the "blueprint" includes 28 specific action areas.
1. Increasing research efforts into the cause, risk factors, prevention, and new treatments of prostate cancer, especially in black men. "There is an urgent need for strong, aggressive nationwide advocacy for more money for research," said Jay Hedlund, executive director of the National Prostate Cancer Coalition.
The blueprint also urges greater coverage by private and public insurers for early screening of men at highest risk for prostate cancer and ensuring the availability of follow-up care and treatment for men with positive screening findings.
Getting Blacks Into Trials
2. Involving African-Americans in the design and implementation of clinical research and the development of culturally relevant educational efforts, and attracting blacks as clinical trial participants.
"One problem in getting African-Americans into clinical trials has been the lack of African-American investigators," noted Isaac J. Powell, MD, chief of urology, Detroit VA Hospital, and associate professor, Wayne State University.
3. Organizing a strong and effective educational program about prostate cancer aimed at the public and at health care professionals, especially primary-care physicians.
The plan notes the need for simple and concise messages about the increased mortality from prostate cancer among African-Americans and the limitations and benefits of early detection methods. "The message should be multifaceted, primarily radio, but also including television and print media," the plan states.
4. Developing and strengthening grassroots organizations, particularly those in the black community, that can successfully engage in advocacy activities at every level of government and society, and participate in education and support programs.
"We have to understand that there are cultural differences in communities across the nation that sometimes serve as barriers to solving health problems," said Thomas W. Dortch, Jr., national president of 100 Black Men of America, whose membership actually numbers about 10,000.
Among blacks, emphasis should be placed on peer education about prostate cancer. "Community members, families, and survivors must assist in framing and delivering messages," the plan states.
5. Developing more community-based support and guidance programs for African-Americans with prostate cancer and their families.
Acknowledging the immensity of such an overall effort, Mr. Dortch, of the 100 Black Men of America group, said: "We know that when Americans come together, we can solve anything."