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Cancer screening guidelines neglect risks for African-American men, say St. Louis-area doctors

Washington University in St. Louis

African-American men are more than twice as likely to die from prostate cancer than men of any other racial group, but a group of St. Louis-area physicians say that disparity was not considered when a U.S. health regulator decided no longer to recommend annual screening tests, regardless of race.

The Prostate Specific Antigen test, or PSA, is often criticized for its high rate of false-positive results. But Dr. Lannis Hall, a radiation oncologist for Siteman Cancer Center in St. Peters, credits the tests with helping alleviate the stark disparity in survival rates between African-American men and white men. 

“And now to take that tool away and leave a high-risk group with no option but to be diagnosed when they come in with clinical symptoms is unacceptable,” Hall said.

Prostate cancer is highly treatable if caught in its early stages. But by the time men experience clinical symptoms such as back pain or urinary difficulties, it’s often too late, Hall said.  

For many years, doctors recommended that men receive prostate cancer screenings between the ages of 50 and 75. In 2012, the U.S. Preventive Services Task Force (which is authorized by Congress to review screening recommendations) determined that the tests were unnecessary for men who do not show symptoms, regardless of age, race or a family history of the disease. The review cited studies that showed screenings had a minimal impact on reducing prostate cancer mortality and more frequently led to false positives and unnecessary treatments.

“The task force found no evidence to suggest that African-American men would benefit more from screening than Caucasian men do or that they would experience less harm,” wrote Dr. Al Siu, a New York-based internist who chaired the committee. He provided a statement by email to St. Louis Public Radio.

“There is a small potential benefit and there are significant known harms,” Siu added. "We need to recognize that current PSA screening and treatment methods are not the answer. We need a better way to screen for and treat prostate cancer." 

Those known harms include infections and other complications when men undergo biopsies after abnormal screening tests. One randomized trial cited in the task force’s recommendation showed that more than one in 10 men received at least one false-positive result after three rounds of testing.

But the studies cited in the task force’s report failed to include adequate numbers of African-American men, the highest risk group for prostate cancer, Hall said. Most studies were conducted in European countries; and in the U.S. study, black men made up only 4 percent of its participants. 

“We are disheartened and frustrated by the fact that there was not representation of the high-risk group, but yet the recommendation not to screen was applied to them,” Hall said. “The evidence they were using could not be applied to the high-risk group.”

After hearing that primary-care doctors were no longer recommending routine prostate cancer screenings, Hall organized a Prostate Cancer Coalition. The group is circulating a petition to encourage physicians to  screen African-American men annually for prostate cancer, beginning at age 45. At the same time, Hall says she hopes to raise awareness among men with the highest risk, so they can discuss screening with their doctors. About 70 people have signed the online document so far.

Leon Ashford, an 85-year-old cancer survivor, is also a member of the committee. Ashford, a retired director of student services at Washington University, was diagnosed with prostate cancer in 1996 after a screening test during an annual checkup.

“It was four biopsies before they detected the cancer,” Ashford remembered. “I really had to stick with this.”

Ashford credits the success of his treatment in the '90s with the fact that his urologist caught the cancer early.

“Based on the pathology report, I don’t think I would have survived,” Ashford said. “Persons should be aware that if you’re in a high-risk group, and if it’s been detected in your family …  you certainly should be tested early.”  

The coalition, which includes the Mound City Medical Forum, supports the American Cancer Society’s recommendationsfor prostate cancer screening: Men should make an informed decision about testing and their own risks for prostate cancer after discussions with their doctor. 

For more health and science news from St. Louis, follow Durrie on Twitter: @durrieB

This post has been updated to clarify that the group's stance on screening guidelines is identical to those proposed by the American Cancer Society.