CHIC: Prostate Cancer Awareness and Screening

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CHIC Prostate Cancer Awareness and Screening

• Sept 31, 2003

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Epidemiology of Prostate Cancer

• 6th most common cause of cancer worldwide
• 220,000 cases will be diagnosed this year in the
  U.S.
• 39,000 men will die of the disease
• 2nd leading cause of cancer death
• 16 lifetime risk for American males of
  developing prostate cancer
• 3 risk of dying from prostate cancer

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Prostate Cancer in Monroe County

• A recent study has indicated that the incidence
  of prostate cancer in Monroe County is 31
  percent higher than the state average
• 577 men in Monroe County diagnosed with prostate
  cancer each year 196 cases per 100,000
• Statewide incidence rate is significantly lower
  150 per 100,000.
• Are local physicians better at detecting prostate
  cancer than elsewhere in NY?

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Methods of Screening

• DRE
• DRE can detect tumors in the lateral and
  posterior areas of the prostate gland.
• Accounts for 65-75 of tumors
• Positive Predictive Value (PPV) varies from
  7-30, dependent in part on concordant serum PSA
  concentration

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Methods of Screening

• PSA (prostate specific antigen)
• Serum PSA value 4.0ng/mL is considered
  suspicious of malignancy in most assays
• 91 overall specificity
• PPV varies from 17-64

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US Preventive Services Task Force Recommendations

• Available evidence is insufficient to recommend
  for or against routine screening for prostate
  cancer using PSA testing or DRE
• Good evidence that PSA screening can detect
  early-stage prostate cancer
• Inconclusive evidence that early detection
  improves health outcomes
• Screening is associated with important harms,
  including false-positive results, unnecessary
  anxiety, invasive testing and potential
  complications of treatment of some cancers that
  may not have otherwise affected a patients health

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CHIC Project Description

• Volunteer with the American Cancer Society (ACS)
• Participation in ACS project at the
  African-American Health Fair held at St. Marys
  Hospital Sept. 20, 2003
• Registration of participants for community
  screening for prostate cancer at Aenon Baptist
  Church Oct. 4, 2003

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CHIC Project Survey

• Creation of questionnaire to assess knowledge
  about prostate cancer and screening trends in the
  African-American community
• Surveyed 25 African-American men, 20 of whom were
  over 45 years old, the recommended age for
  prostate cancer screening by the ACS
• All men asked 5 questions about prostate cancer
  prevalence and their personal opinions about risk
  and experience with the disease
• Men over 45 years of age asked 3 additional
  questions regarding their experiences with
  prostate cancer screening

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Survey Results
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Survey Results
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Results Community and Personal Impact of
Prostate Cancer

• Findings (n of 24)
• 48 of men knew someone who had been diagnosed
  with prostate cancer
• Individuals tended to overestimate the actual
  risk of developing prostate cancer
• 78 of men surveyed felt that prostate cancer was
  a significant problem in the community
• Only 30 felt that they were personally at risk

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Results Screening Trends

• 85 of men over 45 had discussed prostate cancer
  screening with their physician
• 70 had undergone screening

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Final question What are the things that can be
improved by doctors or health care workers to get
more people to know about this disease?

• More health fairs like this
• Ads on the radio
• Presentations at church groups
• Advertising specifically in black newspapers and
  in the black media

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CHIC Project Projected Impact

• Registration of numerous men for prostate cancer
  screening event on October 4, 2003.
• Discussion with two dozen individuals regarding
  facts about prostate cancer and recommendations
  for screening.
• Increased awareness of American Cancer Society
  services and upcoming events including smoking
  cessation, fund-raising walk for breast cancer,
  and prostate cancer screening.

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Take away messages

• Many men in the African-American community have
  had friends or family members diagnosed with
  prostate cancer
• The majority of men feel that prostate cancer is
  a significant problem in the community
• The majority of men actually overestimate the
  population risk of prostate cancer.
• Despite these trends, the majority of men do not
  feel that they are personally at risk!

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Take away messages

• No one surveyed identified specific
  barriers to prostate cancer screening. 85 of
  men over 45 have discussed prostate cancer with
  their physicians. By raising awareness of this
  disease via efforts such as community health
  fairs and advertising campaigns, we may help
  reach the remaining 15 of men.

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References

• U.S. Preventive Services Task Force. Prostate
  Cancer Screening Release Date December 2002
  http//www.ahcpr.gov/clinic/uspstf/uspsprca.htm
• American Cancer Society. Cancer facts and
  figures, 2001-2002. http//www.cancer.org.
• Brawley, Otis and Garnick, Marc. Up To Date
  Online Risk factors and screening for prostate
  cancer. http//www.utdol.com.
•  Harris RP, Lohr KN, Beck R, Fink K, Godley P,
  Bunton A. Screening for Prostate Cancer.
  Systematic Evidence Review No. 16. Rockville,
  MD Agency for Healthcare Research and Quality.
  December 2001. http//www.ahrq.gov/clinic/serfiles
  .htm. 
• Leingang, Matt. High male cancer here probed.
  Rochester Democrat and Chronicle. September 12,
  2003.