Prostate cancer screening in Black men in Canada: a case for risk-stratified care

Otiono, Kikachukwu; Nkonge, Brenda; Olaiya, Oluwatobi R.; Pierre, Sean A.

doi:10.1503/cmaj.220452

Cited by 4 publications

(4 citation statements)

References 51 publications

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“…We also support calls for more research on ways to address specific inequities not addressed by this guidance, such as prostate cancer in Indigenous and Black males. 246,247 Limitations Indigenous health could be specifically addressed through an Indigenous-led process focused on preventive care for Indigenous people, which ours was not, although our recommendations might benefit many groups experiencing disadvantages.…”

Section: Gaps In Knowledgementioning

confidence: 86%

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Preventive care recommendations to promote health equity

Persaud,

Sabir,

Woods

et al. 2023

CMAJ

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Background: Avoidable disparities in health outcomes persist in Canada despite substantial investments in a publicly funded health care system that includes preventive services. Our objective was to provide preventive care recommendations that promote health equity by prioritizing effective interventions for people experiencing disadvantages. Methods: The guideline was developed by a primary care provider–patient panel, with input from a patient-partner panel with diverse lived experiences. After selecting priority topics, we searched for systematic reviews and recent randomized controlled trials of screening and other relevant studies of screening accuracy and management efficacy. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to develop recommendations and followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) reporting guidance. We managed competing interests using the Guideline International Network principles. The recommendations were externally reviewed by content experts and circulated for endorsement by national stakeholders. Recommendations: We developed 15 screening and other preventive care recommendations and 1 policy recommendation on improving access to primary care. We recommend prioritized outreach for colorectal cancer screening starting at age 45 years and for cardiovascular disease risk assessment, to help address inequities and promote health. Specific interventions that should be rolled out in ways that address inequities include human papillomavirus (HPV) self-testing, HIV self-testing and interferon-γ release assays for tuberculosis infection. Screening for depression, substance use, intimate partner violence and poverty should help connect people experiencing specific disadvantages with proven interventions. We recommend automatic connection to primary care for people experiencing disadvantages. Interpretation: Proven preventive care interventions can address health inequities if people experiencing disadvantages are prioritized. Clinicians, health care organizations and governments should take evidence-based actions and track progress in promoting health equity across Canada.

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Section: Gaps In Knowledgementioning

confidence: 86%

“…We also support calls for more research on ways to address specific inequities not addressed by this guidance, such as prostate cancer in Indigenous and Black males. 244 , 245 …”

Section: Gaps In Knowledgementioning

confidence: 99%

Preventive care recommendations to promote health equity

Persaud,

Sabir,

Woods

et al. 2023

CMAJ

View full text Add to dashboard Cite

show abstract

“…A Canadian study highlighted the paucity of PCa data on Black men in the Canadian health care system and an associated overreliance on data from other countries, most commonly US data. 41 This has been partially rectified with a retrospective publication looking at men from the 1991 Canadian long-form census with data out to 2010. 42 Black men had similar rates of PCa-specific mortality, and in fact the HR was less than 1 (HR, 0.83; 95% CI, 0.67-1.02).…”

Section: Discussionmentioning

confidence: 99%

Prostate Cancer Among Black Men in Canada

Albers,

Bashir,

Mookerji

et al. 2024

JAMA Netw Open

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ImportanceProstate cancer is a prevalent disease among men worldwide, exhibiting substantial heterogeneity in presentation and outcomes influenced by various factors, including race and ethnicity. Disparities in incidence, stage at diagnosis, and survival rates have been observed between Black men and those of other races and ethnicities.ObjectiveTo compare prostate cancer outcomes between Black men and men with other race (Asian, Hispanic, Indigenous, Middle Eastern, White, Multiracial, and Other) in a universal health care system, with race and ethnicity self-reported.Design, Setting, and ParticipantsThis was a prospective, observational cohort study of men diagnosed with prostate cancer between June 1, 2014, and August 28, 2023, who self-identified race and ethnicity. Participants included men who had been prospectively enrolled in the Alberta Prostate Cancer Research Initiative from the 2 major urology referral centers in Alberta (University of Alberta and University of Calgary). All men with prostate cancer enrolled in the initiative were included.ExposureRace and ethnicity.Main Outcomes and MeasuresThe primary outcome was the stage and grade of prostate cancer at diagnosis. Further outcomes included age and prostate-specific antigen level at diagnosis, initial treatment modality, time from diagnosis to initial treatment, and prostate cancer–specific, metastasis-free, and overall survivals.ResultsA total of 6534 men were included; 177 (2.7%) were Black, and 6357 (97.3%) had another race or ethnicity. Men who identified as Black were diagnosed with prostate cancer at an earlier age (mean [SD], 62.0 [8.2] compared with 64.6 [7.7] years; P &lt; .001) and had a lower Charlson Comorbidity Index rating (14% compared with 7% ≤ 1; P &lt; .001) compared with men of other races. Men who identified as Black had similar prostate-specific antigen levels at diagnosis, TNM category (74% vs 74% with T1-T2; P = .83) and Gleason Grade Group (34% compared with 35% Gleason Grade Group 1; P = .63). Black men had similar rates of prostate cancer–specific (hazard ratio [HR], 1.10; 95% CI, 0.41-2.97; P = .85), metastasis-free (HR, 0.88; 95% CI, 0.42-1.46; P = .44), and overall (HR, 0.55; 95% CI, 0.25-1.24; P = .15) survival.Conclusions and RelevanceThe findings of this cohort study suggest that Black men, despite being diagnosed at a younger age, experience comparable prostate cancer outcomes compared with men of other races.

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“…Nous nous prononçons également en faveur de recherches plus approfondies sur la façon de lutter contre d’autres iniquités que le présent document n’aborde pas, par exemple, celle qui touche le cancer de la prostate chez les hommes autochtones et de race noire 246 , 247 .…”

Section: Connaissances à Parfaireunclassified

Recommandations pour des soins préventifs pour promouvoir l’équité en matière de santé

Persaud,

Sabir,

Woods

et al. 2023

CMAJ

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Résumé Contexte: Malgré des investissements importants dans un système de soins de santé public qui comprend des services préventifs, on continue d’observer des disparités évitables en matière de santé au Canada. L’équipe avait pour objectif de formuler des recommandations pour des soins de santé préventifs qui puissent améliorer l’équité en matière de santé par la priorisation des interventions efficaces à l’intention des groupes défavorisés. Méthodes: La ligne directrice a été élaborée par un comité composé de spécialistes en soins primaires et de membres de la patientèle, avec la contribution d’un groupe de patientes-et patientspartenaires ayant vécu diverses expériences. Après avoir sélectionné les sujets à prioriser, nous avons recensé les revues systématiques, les essais randomisés et contrôlés récents sur les méthodes de dépistage et d’autres études pertinentes sur l’efficacité du dépistage et de la prise en charge. Nous avons utilisé l’approche GRADE (Grading of Recommendations, Assessment, Development and Evaluation) pour formuler les recommandations et avons suivi le guide AGREE II (Appraisal of Guidelines for Research and Evaluation) pour rédiger le rapport. Il en a été de même avec les principes du Guidelines International Network pour la gestion des intérêts concurrents. Les recommandations ont été passées en revue par un comité externe d’experts en contenu avant d’être distribuées à des intervenants à l’échelle nationale pour approbation. Recommandations: Nous avons formulé 15 recommandations concernant le dépistage et d’autres soins préventifs et 1 recommandation de nature politique visant à améliorer l’accès aux soins primaires. Ainsi, nous recommandons de prioriser une stratégie de communication pour le dépistage du cancer colorectal à partir de l’âge de 45 ans et pour l’évaluation du risque de maladie cardiovasculaire pour lutter contre les iniquités en matière de santé et promouvoir la santé. Les interventions particulières qui devraient être déployées pour lutter contre les iniquités comprennent l’autodépistage du virus du papillome humain (VPH) et du VIH, et le test de libération de l’interféron γ pour l’infection tuberculeuse. Le dépistage de la dépression, de la toxicomanie, de la violence conjugale et de la pauvreté devrait également permettre aux personnes touchées d’accéder plus facilement à des interventions éprouvées. Nous recommandons une prise de contact systématique avec des professionnels de la santé en soins primaires pour les personnes défavorisées. Interprétation: Les interventions préventives éprouvées peuvent aider à combattre les iniquités en matière de santé si la priorité est accordée aux personnes défavorisées. Les médecins, les organisations de santé et les gouvernements devraient adopter des mesures fondées sur des données probantes et en faire le suivi s’ils veulent promouvoir l’équité en matière de santé partout au Canada.

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Prostate cancer screening in Black men in Canada: a case for risk-stratified care

Cited by 4 publications

References 51 publications

Preventive care recommendations to promote health equity

Preventive care recommendations to promote health equity

Prostate Cancer Among Black Men in Canada

Recommandations pour des soins préventifs pour promouvoir l’équité en matière de santé

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