Stigma, beliefs and perceptions regarding prostate cancer among Black and Latino men and women

Abstract

Background Health disparities in prostate cancer (PC) are thought to reflect the complex interplay of socioeconomics, environment and biology. The potential impact of beliefs and perceptions about PC among Black and Latino populations on clinical disparities are not well understood. This qualitative study was conducted to assess current prevalent and pervasive stigma, beliefs and perceptions regarding PC among Blacks and Latinos living in a large metropolitan area, thereby identifying potentially modifiable barriers to care. Methods Qualitative data were collected through four separate focus groups of self-identified Black and Latino adult men and women living in Philadelphia to better understand their perceptions of PC diagnosis, screening and treatment. Each focus group was single-sex and conducted by racial/ethnic group in order to assess possible differences in beliefs about PC based on gender and racial/ethnic affiliation. Audio recordings were transcribed verbatim by trained research assistants and qualitative data analysis was conducted using modified grounded theory. Results There were a total of 34 participants: 19 Hispanics/Latinos and 15 Blacks, with equal numbers of men and women (n=17). Median age was 57 years (range: 18 to 85 years). Dominant themes that emerged with respect to PC diagnosis included the stigma surrounding this condition and the perceived role of an “unhealthy lifestyle” and certain sexual behaviors as risk factors for PC development. While the majority of participants acknowledged the importance of PC screening and early detection, discussion centered around the barriers to both the interest in seeking medical care and the likelihood of securing it. These barriers included misunderstanding of PC etiology, distrust of the medical profession, and financial/access limitations. Men expressed substantial confusion about PC screening guidelines. In the Black female group, the role of faith and religion in the course of disease was a major theme. Both Black and Latina females discussed the role of fear and avoidance around PC screening and treatment, as well as the prevalence of misinformation about PC in their familial and social communities. Conclusion Black and Latino focus groups revealed the existence of cultural beliefs, misunderstandings and fears pertaining to PC which could influence health-related behaviors. Some themes were common across groups; others suggested racial and gender predilections. Future targeted efforts focused on directly addressing prevalent misperceptions among underserved communities in urban settings could help to improve health literacy and equity in PC outcomes in these populations.

Racial disparities in Black men with prostate cancer: A literature review

“…1; see also Video S1). 82 Economic disparities are prevalent within the Black community, and financial hardship influences the decision to seek and/or select PCa screening/treatment, in which costs of diagnostic tests and treatment, treatment time, and recovery time are key factors. The advancement and introduction of novel diagnostic technologies will only increase existing disparities; therefore, addressing socioeconomic factors through development of an equitable care delivery model ultimately can affect the outcomes of more patients (e.g., the Health Impact Pyramid) 83 .…”

Barriers to healthcare

“…Additionally, Black men and women view prostate cancer with a stigmatization 12. Their stigmas relate to the discomfort of the screening process and their fear of erectile dysfunction after removal of the prostate 12. The lack of awareness, education, and stigmatization surrounding prostate cancer influenced the participants' views on seeking preventive care and seeking treatment.…”

“…Black male patients are 70% more likely to be diagnosed with prostate cancer and two times more likely to die from prostate cancer than White patients. Black men are also less likely to seek preventive treatment for prostate cancer 12…”

Quitting smoking after a cancer diagnosis is associated with reductions in stigma and anxiety: A longitudinal mediation analysis.

“…Additionally, stigma can be internalized by patients, indicated by feelings of guilt, shame, and self-blame about one’s own cancer (Amini-Tehrani et al, 2021; Phelan et al, 2013; Williamson, Ostroff, et al, 2020; Williamson et al, 2022). Higher perceived and internalized stigma have been associated with adverse psychological and physical health outcomes across different cancer types (Cataldo & Brodsky, 2013; Cho et al, 2013; Chu et al, 2021; Else-Quest et al, 2009; Ostroff et al, 2019; Phelan et al, 2013; Williamson et al, 2022) and have been well-established as barriers to screening for lung, breast, cervical, and colorectal cancer (Carter-Harris et al, 2014; Goldman et al, 2009; Vapiwala et al, 2021; Vrinten et al, 2017). As such, it is important to identify risk factors for high internalized stigma as well as strategies that reduce cancer stigma.…”