JJunior Hemans was undergoing a routine physical in 2014 when he was diagnosed with prostate cancer at age 51. He knew black men were at increased risk for the disease, so he asked for a prostate specific antigen (PSA) test, which was not initially included.
“And when I came in, they told me my PSA level was elevated for my age,” Hemans said. “[The diagnosis] it was a shock… because I didn’t have any symptoms.”
The PSA test, which is used to detect diseases such as prostate cancer or prostate enlargement, is not typically offered in the United States. National Health Service at present.
The fact that Hemans had to specifically request a PSA test is why he firmly believes there should be a national screening program for men at highest risk of the disease.
“Imagine if, when I was 51, there was already a screening program in place. [before my diagnosis]”I could have been diagnosed earlier,” he says. “The screening program saves more people and gives us better, cheaper ways to save that person.”
Although Hemans, who is now successfully treated for the disease, was aware of his increased risk, he said he knew many other black men who did not have the same knowledge.
Prostate cancer has overtaken breast cancer as most commonly diagnosed cancer in England, but there is no national screening program despite more than 55,000 new cases being reported each year. One in eight men will be diagnosed with the disease in their lifetime, but black men face a much higher risk of one in four.
The UK's National Screening Committee (NSC) is due to decide at the end of the month whether to recommend the NHS introduce a prostate cancer screening programme, with experts calling for it to be targeted at high-risk groups, including black men.
Keith Morgan, deputy director of black health equity at Prostate Cancer UK, said the evidence for a screening program targeting black men was “particularly strong” given they are at increased risk of prostate cancer. late stage of diagnosis as well as higher mortality rates.
“And this cannot be simply explained by where they live, as our latest report shows that even in the least deprived areas, black men are dying from prostate cancer at higher rates than white men in the most deprived areas,” Morgan said. “Leaving testing to chance perpetuates this inequality and creates a fatal postcode lottery.
“We now believe that the evidence must be strong enough for the NSC to recommend targeted screening for black men. While there are other groups, such as those with a family history of the disease, who we believe may also benefit from targeted screening, it is black men who are most affected.”
The charity said that if the NSC does not agree, it will challenge the government to develop a clear plan to tackle late diagnosis and inequalities.
Morgan added: “It's clear we can't just leave this to chance for black men. If the NSC decides we're not ready for screening, the government must act quickly to fund serious communication work and change outdated recommendations so GPs can proactively talk to black men about their risk and choice to have a PSA blood test.”
David James, Director of Patient Projects and Impact at Prostate Cancer The study found there was “sufficient evidence” to demonstrate the benefits of a screening program, starting with those most at risk.
“These are black men aged 45 to 69, men with a relevant family history of prostate, breast or ovarian cancer in the same age group, and people with certain genetic mutations,” James said.
“We believe that we have demonstrated that such a screening program is cost-effective and in fact brings positive socio-economic benefits to the country as a whole, and that it does not overburden the NHS. We very much hope that the National Screening Committee and the government will decide in favor of the screening program.”
However, this view is not a consensus among prostate cancer researchers and scientists, with some arguing that more evidence is needed to address concerns that a targeted screening program may lead to potential overdiagnosis.
Nasser Turabi, director of evidence and implementation at Cancer Research UK, said the evidence for targeted screening was still “very unclear”.
“There is a lot of conflicting evidence,” Turabi said. “For example, for black men [increased risk of prostate cancer] It is likely a mixture of environmental and genetic factors.
“Although they have a higher incidence of prostate cancer, the PSA test [is] is used to detect prostate specific antigen, and black men have higher natural PSA levels, which may lead to overdiagnosis among black men.”
For Turabi, lumping all black men into a general category can be problematic due to the great diversity within the group.
“I think another problem is that black itself is a social category, which is different from thinking about ancestry,” Turabi said. “There may be some indication that this is true, that some of the genetic risks for people of African descent apply to a subgroup of what we would call black men.
“One of the challenges here is that we don't have a lot of genomic data on black men, people of African descent, as a general population.”
Ryan Geib, professor of biostatistics and clinical trials at Queen Mary University of London, agreed. She said, “I don't think there's a ton of evidence for black men because, unfortunately, I don't think we have enough studies that include black men. And that's what we're trying to do.”
Gabe is also co-lead of the Transform trial. £42 million UK prostate cancer screening trial whose goal is to find better methods for screening for the disease. One in 10 participants in the 20-year study will be black men, and the sample size is much larger than in previous clinical studies.
“That's why we're committed to getting as many black men as possible into our study because we really want that evidence and we really want to give them the opportunity to take part in our study,” she added.
Harveer Dev, an academic urologist at the University of Cambridge's Early Cancer Institute, said that whether or not the NSC recommends a screening program, the situation has changed.
“I think the public's attitude towards this issue needs to be taken into account, if not completely dictating the decision, then at least partially,” Dev added.
