Prostate cancer prevention in men of African ancestry: What does culture have to do with it? A comparative analysis of African American men and Bahamian men

Background: Prostate cancer (PCa) mortality rates in African American men are up to 6 times higher than other ethnic groups. Similarly, Bahamian men experience high but also increasing PCa mortality despite widespread public campaigns with free access and availability to early cancer detection programs. We hypothesize that cultural influences in men of African ancestry counteract healthy life style seeking behaviors for early detection of PCa, and men perceive that PCa is not important, resulting in dissonance and self-handicapping behavior.

Methods: Preliminary quantitative comparative analysis based on a social ecological framework was conducted between two samples of men of African ancestry (African American men and Bahamian men). Participants completed a 160-question multiple item questionnaire. We investigated descriptive statistics for clues of PCa screening importance. Outcome variables included PCa specific antigen (PSA) blood test and digital rectal exam (DRE).

Results: N=335, African American male sample=276 (mean age 52.9 years, SD=9.2 years) and Bahamian male sample=59 (mean age 50.3 years, SD=11.3 years); 79.3% African American men had health coverage compared to 59.3% Bahamian men; 28.8% Bahamian men never had PSA compared to 40.8% of African American men; and 45.8% Bahamian men compared to 36.8% African American men report no DRE. When asked if they knew of the PSA and DRE, 70% of Bahamian men knew about PSA and DRE compared to 53.4% of African American men who knew of PSA, but 70.4% knew of DRE. When asked why men of African ancestry do not get screened, 73.3% African American men believed they were not at risk for PCa, compared to 59.3% of Bahamian men. When asked if PCa is important, both African American men (69.5%) and Bahamian men (69.5%) felt PCa is not important right now.

Conclusion: Preliminary findings indicate a strong association between cultural health values, beliefs, practices, risk for illness and disease, and what constitutes a ‘healthy' state; these are seminal factors affecting health-seeking behaviors. This paper will discuss implications for intervening in this complex interplay between culture, decision-making, screening, and physician/patient communication.