The life span of young males with prostate cancer is influenced by socioeconomic factors.
In general, prostate cancer is considered a disease of older men. However, approximately 10% of new cancer diagnoses occur in men aged 55 or younger, and these malignancies typically have a poorer prognosis. The difference is partially explained by biological differences. For instance, certain genetic abnormalities are more prevalent in prostate cancers diagnosed in younger men than in elderly men with the disease.
New research from the Jacksonville College of Medicine (JCM) in Florida suggests that socioeconomic factors also play a significant role. It is well established that poverty, educational level, and other socioeconomic status (SES) factors affect cancer survival.
This is the first study to examine how SES affects survival, specifically in early-onset prostate cancer. The findings indicate that men with a lower SES do not survive as long as those with a higher SES. "They're more likely to be diagnosed in advanced stages," says Dr. Carlos Riveros, a physician and research associate at JCM and the paper's lead author.
What the study discovered
Dr. Riveros and his colleagues analysed data from the National Cancer Database (NCD), which is supported by the American College of Surgeons and the National Cancer Institute, during the investigation. The NCD collects information from more than 1,500 institutions across the United States. Between 2004 and 2018, Dr. Riveros's team focused specifically on long-term outcome data for 112,563 men diagnosed with early-onset prostate cancer.
The researchers could determine each patient's postal code. Then, they examined the per-capita income and the percentage of residents who lacked a high school diploma for each of the respective zip codes. The combined income and education data served as a composite SES measure for the population of each zip code. In the concluding step, the team compared the survival rates of patients with early-onset prostate cancer across zip codes.
In comparison to high-SES patients, low-SES men were significantly more likely to be African-American and less likely to have health insurance. More men with low socioeconomic status lived in rural areas and were diagnosed with prostate cancer at stage IV. Fewer low-SES patients were treated at cutting-edge cancer centres, and fewer of them underwent surgery.
After adjusting for age, race, ethnicity, cancer stage, and treatment, men with lower SES were 1.5 times more likely to have died during a median follow-up of 79 months than men with higher SES.
Observations and observations
According to Dr. Riveros, the findings are consistent with evidence indicating that social determinants of health — the conditions in places where people work and reside — have broad effects on the risk of cancer. "Many low-socioeconomic-status residents have had poor diets since birth," he says.
Dr. Riveros explains that individuals with a lower socioeconomic status may have limited access to, comprehension of, or application of health-related information. As a result, they "may not know what advanced prostate cancer feels like or when it's time to see a doctor." When implementing programmes to enhance the management of patients with early-onset prostate cancer, he and his co-authors concluded that SES should be taken into account.
Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Centre, explains, "This paper emphasises the importance of addressing diversity, equity, and inclusion issues when it comes to optimising outcomes for men with prostate cancer."
Dr. Heidi Rayala, a urologist at Beth Israel Deaconess Medical Centre in Boston and a member of the editorial board of the Harvard Medical School Annual Report on Prostate Diseases, concurs but adds that evaluating individual sociodemographic factors is difficult because many of them are coupled with disparities in insurance coverage. "What remains unanswered is whether there are unique underlying SES factors that would benefit from targeted cancer prevention strategies or if this all boils down to the 10% of the US population that remains uninsured," she says.
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