Recent research from Wake Forest University School of Medicine shows that American Indian and Alaska Native men are less more likely to be screened for prostate cancer in comparison with other racial/ethnic groups.

The study appears online in Cancer Causes & Control.

Our findings highlight a major health-care disparity in accessing care.”

Chris Gillette, Ph.D., associate professor of PA Studies at Wake Forest University School of Medicine and principal investigator of the study

In response to the American Cancer Society, there are greater than 34,000 prostate cancer deaths within the U.S. every year, and prostate cancer is the second-leading explanation for cancer death in men. American Indian and Alaska Native men are less more likely to be diagnosed with prostate cancer. Nonetheless, their prostate cancer outcomes are much worse than other racial/ethnic groups, especially for men between the ages of 50-59 years old.

There are two tests that providers can use which may help diagnose prostate cancer. One is a digital rectal exam (DRE), and the opposite is a blood test that measures the quantity of prostate-specific antigen (PSA). Elevated levels of PSA within the bloodstream might be indicative of prostate cancer.

For the study, researchers conducted a secondary evaluation of the National Ambulatory Medicare Care Survey (NAMCS) datasets from 2013-2016 and 2018 and the NAMCS Community Health Center (CHC) datasets from 2012–2015. NAMCS is a nationally representative sample of visits to non-federal office-based physician clinics while the CHC samples include outpatient visits to physicians, physician assistants and nurse practitioners at community health centers including federally qualified health centers and Indian Health Service clinics. Within the NAMCS dataset, researchers analyzed 509,737,580 visits over a five-year period of which 232,998 were for American Indian and Alaska Native men.

“We found that American Indian and Alaska Native men were significantly less more likely to receive a PSA than non-American Indian and Alaska Native men,” Gillette said. “Essentially the most alarming finding is that there have been zero instances of DREs within the NAMCS dataset over the complete five-year period, and there have been no PSAs conducted in American Indian/Alaska Native men after 2014.”

Within the NAMCS dataset, the speed of PSAs being ordered for American Indian and Alaska Native men was 1.67 per 100 visits but included no DREs. The speed of PSAs for non-American Indian and Alaska Native men was 9.35 per 100 visits while the prevalence of DRE was 2.52 per 100 visits.

In analyzing the CHC dataset, the researchers noted that American Indian and Alaska Native men had barely lower rates of PSAs (4.26 per 100 visits v. 5.00/100) and DREs (0.63 per 100 visits vs. 1.05 per 100) than non-Hispanic White men, but this difference was not statistically significant.

“We found that the disparity may not exist when men visit community health centers,” Gillette said. “More research is required to raised understand why.”

In response to Gillette, American Indian and Alaska Native men also experience disproportionately greater prostate cancer mortality in comparison with other racial/ethnic identities because they present for care when their prostate cancer is more advanced in comparison with other racial/ethnic groups, which could also be a direct results of not getting PSAs and DREs at the identical rate as other racial/ethnic groups.

Current screening guidelines recommend that providers use shared decision-making to debate the advantages and risks of PSA and DRE because current screening tools can result in false-positive results and the necessity for more aggressive testing. As men age, the chance of a false-positive result also increases.

Gillette noted due to the best way information was compiled for the datasets, it’s inconceivable to know whether shared decision-making was used when discussing PSA and/or DRE and whether the choice aligned with American Indian and Alaska Native men’s preferences.

“Additional research is required to explore how providers discuss PSA and DRE with this population, why there are differences in screening practices and to look at access to care,” Gillette said.

Gillette collaborated on the study with the Office of Cancer Health Equity at Atrium Health Wake Forest Baptist’s NCI-designated Comprehensive Cancer Center.