Minority Outreach Key to UAB Prostate Cancer Research Compliance Rate

Education and awareness are major factors in the 95 percent compliance rate the University of Alabama at Birmingham (UAB) has maintained eight years into a prostate cancer trial, said principal investigator Dr. Mona Fouad, MPH. A more common 60 or 70 percent compliance rate among trial participants “would be great after all these years … but we’ve been very diligent,” said Fouad, director of the UAB Minority Health and Research Center and an organizer of Prostate Cancer Summit 2007, which was held recently in Birmingham. “We feel like our success is because when we were recruiting the participants, we gave them enough information so they made a good, informed decision and a commitment. “We spent a lot of time going out to the community, conducting town hall meetings. We didn’t just invite them to our clinic. We went out there in groups to educate them about the study and (to answer) ‘why’ and ‘what is this about,’ and present this to them in their own environment.” UAB is one of 10 sites funded by the National Cancer Institute (NCI) in a 17-year trial called the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). In Alabama, UAB enrolled approximately 6,200 participants in PLCO, Fouad said. Half of the participants are men, who are screened for prostate cancer with a prostate-specific antigen (PSA) test and a digital rectal exam. In addition to the high compliance rate, “the other unique thing about our site is that we were designated by NCI as a minority extension center, which means that we were charged to enroll a large proportion of our participants from the African American population,” Fouad said. “The whole national study has only 4 percent (African American participants), but UAB has 30 percent.” Fouad’s colleague Dr. Christopher Amling, director of the UAB Division of Urology, was a speaker at Prostate Cancer Summit 2007. Amling agrees that community outreach is central to educating African Americans about prostate cancer screening. “First of all, a lot of screening has to do with access to medical care,” Amling said. “You have to have access to a medical system that allows you to get screened. Number two, you have to be interested in wanting to know whether you have prostate cancer. Men who don’t know much about prostate cancer and how to screen for it are not going to present for screening. So you bring it to them in a more comfortable environment and help them understand what it means.” He went on, “We’re talking about a cancer that is the second-leading cause of cancer death in the country and a significant disparity: You are 2.5, 2.4 times more likely to die from prostate cancer if you’re African American than if you’re not. The question is, is that because the word is not getting out? Is that because people aren’t coming in to get screened? Is that because of lack of access to care? Or is that truly a racial difference in how the cancer behaves? There’s a lot of belief that it has to do with men not getting screens and for some of these other issues — education and access to care — more so than the fact that African American men truly have a more aggressive cancer. It might just be that they are just presenting later with a more aggressive cancer because they never learned about screening or about how to detect their prostate cancer.” “It’s a very aggressive disease,” Fouad said. “It starts at an earlier age (in African Americans), and the mortality rate is very high. We’re not sure, but probably two things contribute to this: One is that it may be a more aggressive disease in African Americans than white men and starts at a younger age, but second, and most probably, is that African Americans detect the disease at a later stage than whites, and because there is no routine screening for prostates yet.” African Americans without access to routine healthcare often are not diagnosed with prostate cancer until symptoms have developed, she said. “Usually there is limited access to care in the African American community, especially in the Southeast,” she said. “There is a high proportion that don’t have insurance, or maybe they don’t want to go to physicians. So we do a lot of information awareness. There are a lot of programs now — especially church-based and other community programs — that promote information awareness about African American men going to speak with their physicians, and if they feel if they are high risk, they need to be screened. We are trying to work towards that.” However, screening with the use of the PSA test is controversial, Amling said. “Are we detecting cancers too early, before they are of any clinical significance?” he said. “Are we detecting cancers that don’t necessarily need to be treated? The counterargument is we are finding cancers early, when they are much more amenable to treatment and cure. So there is some controversy about how aggressively we should screen and who we should screen, what populations of men we should go looking for it in and at what age to start screening.” August 2007