Prostate Cancer Screening Behavior in Men from Seven Ethnic Groups: the Fear Factor

Abstract

Rates of prostate cancer screening are known to vary among the major ethnic groups. However, likely variations in screening behavior among ethnic subpopulations and the likely role of psychological characteristics remain understudied. We examined differences in prostate cancer screening among samples of 44 men from each of seven ethnic groups (N = 308; U.S.-born European Americans, U.S.-born African Americans, men from the English-speaking Caribbean, Haitians, Dominicans, Puerto Ricans, and Eastern Europeans) and the associations among trait fear, emotion regulatory characteristics, and screening. As expected, there were differences in the frequency of both digital rectal exam (DRE) and prostate-specific antigen (PSA) tests among the groups, even when demographic factors and access were controlled. Haitian men reported fewer DRE and PSA tests than either U.S.-born European American or Dominican men, and immigrant Eastern European men reported fewer tests than U.S.-born European Americans; consistent with prior research, U.S.-born African Americans differed from U.S.-born European Americans for DRE but not PSA frequency. Second, the addition of trait fear significantly improved model fit, as did the inclusion of a quadratic, inverted U, trait fear term, even where demographics, access, and ethnicity were controlled. Trait fear did not interact with ethnicity, suggesting its effect may operate equally across groups, and adding patterns of information processing and emotion regulation to the model did not improve model fit. Overall, our data suggest that fear is among the key psychological determinants of male screening behavior and would be usefully considered in models designed to increase male screening frequency. (Cancer Epidemiol Biomarkers Prev 2006;15(2):228 -37) Prostate cancer is the second leading cause of cancer death among American men (1); there are striking ethnic differences in both its incidence and mortality (2). Compared with both European American (172.9 of 100,000) and Hispanic men (127.6 of 100,000), African American men (275.3 of 100,000) have the highest incidence of prostate cancer in the United States (3) and more than twice the mortality rate of European Americans (2). Conversely, although the incidence rates between 1995 and 1999 were f20% lower among Hispanic men, prostate cancer remains the most commonly diagnosed cancer and the second leading cause of cancer death within this group (4).Scientists know almost nothing about prostate cancer in Caribbean subpopulations. Research has, however, indicated that Jamaican men (who are often classified as ''African American'') may have an incidence rate that exceeds that of U.S.-born African Americans. One study of 2,484 men in Trinidad and Tobago, a major source of English-speaking Caribbean immigrants to the United States, suggested that the rate of prostate cancer may be as high as 10% (5), with a high number of abnormal screening findings (6). Research in Kingston, Jamaica likewise suggests that the incidence may be as high as 304...

Cancer Screening and Haitian Immigrants: The Primary Care Provider Factor

“…Consedine et al found that Haitian men reported significantly lower prostate cancer screening compared with U.S. born whites [3]. Haitian women have been found to be less likely to utilize breast cancer screening [4,5], and have lower Papanicolaou (Pap) test screening rates than native-born Black and Latina peers [6], and a higher incidence of invasive cervical cancer than U.S.-born black women [7].…”

Barriers and Facilitators to Digital Rectal Examination Screening Among African-American and Afro-Caribbean Men

“…However, once high screening fear men had undergone at least one DRE, they were just as likely to maintain annual DRE's as those with low screening fear. Prior work by Consedine et al 17,25 found that fear of screening, especially embarrassment and discomfort regarding DRE's, is a significant barrier to prostate cancer screening, while prostate cancer worry is a facilitator to screening. Concern and worry may follow a bimodal distribution: moderate levels may promote health behaviors, while high levels promote denial and avoidance.…”

“…These finding are consistent with other studies suggesting that men from minority populations have high levels of worry about prostate cancer and are particularly averse to DRE testing. 17, 27, 28 DRE's have unique psychological demands for men which may be intensified given the similarities between the test itself and the disease for which it is screening regarding issues of vulnerability, humiliation, and sexuality. 7,17 Another important finding of the study is the importance of ethnicity in DRE screening behavior.…”

“…17, 27, 28 DRE's have unique psychological demands for men which may be intensified given the similarities between the test itself and the disease for which it is screening regarding issues of vulnerability, humiliation, and sexuality. 7,17 Another important finding of the study is the importance of ethnicity in DRE screening behavior. African-American, Jamaican, and Trinidadian/Tobagonian men had significantly fewer DRE screenings than white males, confirming the findings of several other studies.…”

“…13,14 A few data suggest that African-American and Afro-Caribbean men are less likely to undergo DRE screening than white men, even after adjusting for socioeconomic status, access to care and comorbidities. [15][16][17][18] Low prostate cancer screening has been associated with lower socioeconomic status, lack of insurance, less prostate cancer knowledge, and weaker physician recommendation. [19][20][21][22] Fear and anxiety related to prostate cancer and the screening process may also represent key barriers that are potentially modifiable.…”