Black Men, Tuskegee and Prostate Cancer

Difficulties getting health care, not lack of information or education, explain why black men fall behind on treatment for prostate cancer, according to a new study in the research journal Cancer. Distrust of medical personnel, while significant, was also not a factor.

Whenever journalists try to explain why black people often distrust doctors in the U.S., someone is bound to bring up the notorious Tuskegee syphilis experiment, in which a group of black men with syphilis were left untreated even after a cure for the sexually transmitted disease had been discovered. Other potential explanations include lack of education or folk beliefs.

But a study of African American men in North Carolina shows that, in this case at least, study subjects were well aware of their heightened risk of prostate cancer. They also accepted personal responsibility for seeking health care. What they didn’t have was easy access to health care or the ability to take time off from their mostly blue-collar jobs to follow up on that care.

The study, which compared 207 African American and 348 Caucasian men who had recently been told they had prostate cancer, found that the black men typically depended on walk-in clinics and emergency departments for their care and so were less likely to see the same doctor regularly. There simply wasn’t time to develop a trusting relationship with a physician. They also had trouble getting time off from work to get to public clinics.

“The problem isn’t in the patients,” says Dr. James Talcott of the Center for Outcomes Research at Harvard Medical School and one of the study's authors. “It’s in the obstacles that their situation presents in getting the care they know that they need.”

What’s particularly important about the way this study was designed is that it doesn’t just measure disparities in health care but the investigators took the next step and actually talked to patients about their situation.

Other researchers had assumed “that because [these men] are less well educated—and they certainly are—means they don’t get it, they don’t understand the problem or modern medicine,” Talcott explains in a telephone interview. “They do get it. These folks are motivated. They understand they have a role in their own health."

"But they just don’t have access," Talcott continues. "They have less insurance. They get their care in inconvenient settings like walk-in settings and emergency depts. That results in greater waits than private settings. They’re more likely to have blue collar jobs, which results in not being able to take time off or extra time off to seek medical care.”

Source: Talcott, et al. Hidden barriers between knowledge and behavior (CANCER, published online: 12 March 2007; DOI: 10.1002/cncr.22583)