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June, 2007

Highlights in Minority Health
& Health Disparities
June, 2006

Focus on Prostate Cancer

June 12-18, 2006 is Men's Health Week
In 2002, 190,096 men were diagnosed with prostate cancer, and 30,446 men died from it .1   Prostate cancer is the most common cancer, excluding skin cancer, and the second-leading cause of cancer-related death in men in the United States.2  It is the sixth leading cause of death for U.S. men overall.3 
Prostate cancer incidence rates rose dramatically in the late 1980s.  This increase reflects improvements in detection and diagnosis through widespread use of prostate-specific antigen (PSA) testing.  In the early 1990s, prostate cancer incidence began declining and has leveled off in recent years (2).  Over the past 20 years, the survival rate for prostate cancer has improved from 67% to 97%.4  The prostate cancer death rate has declined from 38.4 per 100,000 in 1990 to 26.5 in 2003.5

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  red arrow In 2003, the prostate cancer death rate for African American men was 57.4 per 100,000 population, more than twice as high as the rate for non-Hispanic whites (24.6), Hispanics/Latinos (20.2), American Indians and Alaska Natives (AI/ANs) (17.8), or Asian Americans and Pacific Islanders (AAPIs) (10.9).5
  red arrow  From 2000-2003, the prostate cancer incidence rate was 1.5 times higher for African Americans (258.3 per 100,000 men) than for the total population (170.3), and 1.6 times higher than for whtie men (163.4).6   Scientists do not know why it is more common in African American men than it is in others.  They are studying possible reasons, including culture, environment, and differences in the biology of the disease in African American men.7
  red arrow The lowest prostate cancer incidence rates were found in AI/AN (70.7 per 100,000 men), followed by AAPIs (96.8), and Hispanics/Latinos (141.1) in 2000-2003.6
  red arrow Age is the most important risk factor for contracting prostate cancer.8  About 70% of all diagnosed prostate cancers are found in men aged 65 years or older.4  From 2000-2003, the median age at diagnosis for prostate cancer was 68 years of age; the highest proportion of cancers were diagnosed in men ages 65-74 (37.0%).6
  red arrow From 1995-2001, African American men had a lower 5-year survival rate (97.6%) than whites (99.9%) and the total population (99.9%).9
  red arrow In 2004, men whose education included a bachelorís degree or higher were almost twice as likely to be diagnosed with prostate cancer (3.0%) than men with less than a high school diploma (1.6%).10
  red arrow In 2004, men in the northeastern U.S. were about 1.5 times more likely to be diagnosed with prostate cancer (2.1%) than men in the southern and western U.S. (1.4% each).10

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There is no scientific consensus on effective strategies to reduce risk of prostate cancer, and public health agencies face significant challenges in determining what actions to take to address prostate cancer.11
Age, race, and those with a family history (those with a father or brother who has had prostate cancer are at greater risk) are the three known risk factors. The digital rectal examination (DRE) and the prostate-specific antigen (PSA) test are two commonly used methods for detecting prostate cancer.12  The U.S. Preventive Services Task Force (USPSTF) found good evidence that PSA screening can detect early-stage prostate cancer but mixed and inconclusive evidence that early detection improves health outcomes.  The Task Force has therefore concluded that the evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE).13.  Race and age are the only clearly identified risk factors for prostate cancer. African Americans and older men are at higher risk.12
To advance efforts targeting prostate cancer, CDC will
  red arrow Conduct surveillance activities to monitor the magnitude and scope of prostate cancer and its incidence and mortality trends in the U.S. population.
  red arrow Implement, as appropriate, recommendations from the December 2000 prostate cancer meeting of health care providers, researchers, survivors, advocates, and others with expertise in prostate cancer; conduct epidemiologic and behavioral research to build the science base for this disease.
  red arrow Promote research to evaluate factors which most impact screening and treatment decisions.
  red arrow Promote and disseminate informed decision-making materials nationwide.11 

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CDC engages in the following activities, which will further efforts to develop and deliver appropriate public health strategies for prostate cancer and will improve information sharing between providers and their patients related to screening.
  red arrow Conduct research and develop materials on how to communicate information and promote informed decision making about prostate cancer screening.
  red arrow Enhance prostate cancer data in cancer registries, especially information on the stage of disease at the time of diagnosis, quality of care, and race and ethnicity of the man diagnosed with prostate cancer.
  red arrow Sponsor research on whether screening for prostate cancer reduces deaths caused by the disease and on knowledge and awareness of prostate cancer screening among men and health care providers.
  red arrow Provide funding to states, tribes/tribal organizations, and U.S. territories for prostate cancer activities identified in their comprehensive cancer control plans.3

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Centers for Disease Control and Prevention (CDC)

National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)

    Cancer Prevention and Control
    Prostate Cancer: The Public Health Perspective
    Prostate Cancer Screening: A Decision Guide
    Prostate Cancer Screening: A Decision Guide for African Americans
    Prostate Cancer Control Initiatives
National Institutes of Health (NIH)

Medline Plus

    Prostate Cancer
    Prostate Diseases

National Cancer Institute (NCI)

    Prostate Cancer
    What You Need to Know About Prostate Cancer

NIH Senior Health

    Prostate Cancer
Federal Citizen Information Center

Understanding Prostate Changes: A Health Guide for All Men

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1. Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Prostate Cancer Control Initiatives
2. National Institutes of Health (NIH), National Cancer Institute (NCI), A Snapshot of Prostate Cancer, 2005
3. CDC, NCCDPHP, 2004/2005 Fact Sheet, Prostate Cancer: The Public Health Perspective
4. CDC, NCCDPHP, 2003 Fact Sheet, Prostate Cancer: The Public Health Perspective
5. CDC, National Center for Health Statistics (NCHS), Health United States, 2005, table 29
6. National Institutes of Health (NIH), National Cancer Institute (NCI), Cancer Stat Fact Sheets: Cancer of the Prostate
7. CDC, NCCDPHP, Cancer Prevention and Control (CPC), Prostate Cancer Screening: A Decision Guide for African Americans, 2006
8. NIH, National Human Genome Research Institute, Prostate Cancer Facts, 2005
9. NIH, NCI, Age-Adjusted SEER Incidence and US Death Rates and 5-Year Relative Survival Rates by Primary Cancer Site, Sex, and Time Period, 1996-2002
10. CDC, NCHS, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2004, table 6
11. CDC, Programs In Brief: Cancer Prevention
12. Healthy People 2010, Chapter 3: Cancer
13. Agency for Healthcare Research and Quality (AHRQ), U.S. Preventive Services Task Force, Screening for Prostate Cancer, 200

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