Racial Variation in Cancer Care: A Case Study of Prostate Cancer

  • Ronnie D. Horner
Part of the Cancer Treatment and Research book series (CTAR, volume 97)


There is convincing documentation of racial variation in the incidence and mortality of many cancers, particularly cancers of the breast, colon, lung, and prostate.[1,2] Racial differences are also reported in the clinical management of these cancers.[3,4] This phenomenon, that is, racial variations in the occurrence and treatment of disease, is not unique to cancers. Racial differences are found in incidence, patterns of care, and patient outcomes for many other diseases and conditions, e.g., cardiovascular and cerebrovascular disease.[5][8] Efforts to further document its existence would seem to be unwarranted.


Prostate Cancer Radical Prostatectomy Racial Difference Localize Prostate Cancer Health Belief Model 


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  1. 1.
    Wingo PA, Bolden S, Tong T, Parker SL, Martin LM, Heath CW. Cancer statistics for African Americans. CA-A Cancer J Clin 1996; 46: 113–125.CrossRefGoogle Scholar
  2. 2.
    Ries LAG, Miller BA, Hankey BF, Kosary CL, Harres A, Edwards BK.(eds.). SEER Cancer Statistics Review, 1973–91. NIH Pub. 94-2789. Bethesda, Md.: National Cancer Institute, 1994.Google Scholar
  3. 3.
    Cooper GS, Yuan Z, Landefeld CS, Rimm AA. Surgery for colorectal cancer: race-related differences in rates and survival among Medicare beneficiaries. Am J Public Health 1996; 86: 582–586.PubMedCrossRefGoogle Scholar
  4. 4.
    Mettlin CJ, Murphy G. The National Cancer Data Base report on prostate cancer. Cancer 1994; 74: 1640–1648.PubMedCrossRefGoogle Scholar
  5. 5.
    Horner RD, Matchar DB, Divine GW, Feussner JR. Racial variation in ischemic stroke-related physical and functional impairments. Stroke 1991; 22: 1497–1501.PubMedGoogle Scholar
  6. 6.
    Whittle J, Conigliaro J, Good CB, Lofgren RP. Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. N Eng J Med 1993; 329: 621–627.CrossRefGoogle Scholar
  7. 7.
    Oddone EZ, Horner RD, Monger ME, Matchar DB. Racial variation in the rates of carotid angiography and endarterectomy in patients with stroke and transient ischemic attack. Arch Intern Med 1993; 153:2781–2786.PubMedCrossRefGoogle Scholar
  8. 8.
    Horner RD, Oddone EZ, Matchar DB.. Theories explaining racial differences in the utilization of diagnostic and therapeutic procedures for cerebrovascular disease. Milbank Q 1995; 73: 443–462.PubMedCrossRefGoogle Scholar
  9. 9.
    Geiger HJ. Race and health care — an American dilemma? N Eng J Med 1996; 335: 815–816.CrossRefGoogle Scholar
  10. 10.
    McWhorter WP, Schatzkin AG, Horm JW, Brown CC. Contribution of socioeconomic status to Black/White differences in cancer incidence. Cancer 1989; 63:982–987.PubMedCrossRefGoogle Scholar
  11. 11.
    Gorey KM, Vena JE. Cancer differentials among US Blacks and Whites: quantitative estimates of socioeconomic-related risks. J Natl Med Assoc 1994; 86: 209–215.PubMedGoogle Scholar
  12. 12.
    Cella DF, Orav EJ, Kornblith AB, Holland JC, Silberfarb PM, Lee KW et al. Socioeconomic status and cancer survival. J Clin Oncol 1991; 9: 1500–1509.PubMedGoogle Scholar
  13. 13.
    Watts ES. The biological race concept and diseases of modern man. In Rothschild HR (ed.). Biocultural Aspects of Disease. New York: Academic Press, Inc., 1981: 3–23.Google Scholar
  14. 14.
    Cooper R, David R. The biological concept of race and the application to public health and epidemiology. J Health Polit Policy Law 1986; 11: 97–116.PubMedGoogle Scholar
  15. 15.
    Witzig R. The medicalization of race: Scientific legitimization of a flawed social construct. Ann Intern Med 1996; 125: 675–679.PubMedGoogle Scholar
  16. 16.
    Osborne NG, Feit MD. The use of race in medical research. JAMA 1992; 267:275–279.PubMedCrossRefGoogle Scholar
  17. 17.
    Schulman KA, Rubenstein LE, Chesley FD, Eisenberg JM. The roles of race and socioeconomic factors in health services research. Health Serv Res 1995; 30: 179–195.PubMedGoogle Scholar
  18. 18.
    Williams DR. The concept of race in Health Services Research: 1966–1990. Health Serv Res 1994; 29: 261–274.PubMedGoogle Scholar
  19. 19.
    Jones CP, LaVeist TA, Lillie-Blanton M. “Race” in the epidemiologic literature: An examination of the American Journal of Epidemiology, 1921–1990. Am J Epidemiol 1991; 134: 1079–1084.PubMedGoogle Scholar
  20. 20.
    Nickens HW. The role of race/ethnicity and social class in minority health status. Health Serv Res 1995; 30: 151–162.PubMedGoogle Scholar
  21. 21.
    Lillie-Blanton M, Parsons PE, Gayle H, Dievler A. Racial differences in health: Not just black and white but shades of gray. Annu Rev Public Health 1996; 17: 411–448.PubMedGoogle Scholar
  22. 22.
    Pappas G. Elucidating the relationship between race, socioeconomic status, and health. Am J Public Health 1994; K6: 892–893.Google Scholar
  23. 23.
    Williams DR, Lavizzo-Mourey R, Warren RC. The concept of race and health status in America. Public Health Rep 1994; 109: 26–41.PubMedGoogle Scholar
  24. 24.
    LaVeist TA. Beyond dummy variables and sample selection: what health services researchers ought to know about race as a variable. Health Serv Res 1994; 29: 2–16.Google Scholar
  25. 25.
    Polednak AP, Flannery JT. Black versus White racial differences in clinical stage at diagnosis and treatment of prostatic cancer in Connecticut. Cancer 1994; 70: 2152–2158.CrossRefGoogle Scholar
  26. 26.
    Roach M, Krall J, Keller JW, Perez CA, Sause WT, Scotte Doggett RL, Rotman M, Russ H, Pilepich MV, Asbell SO, Shipley W. The prognostic significance of race and survival from prostate cancer based on patients irradiated on radiation therapy oncology group protocols (1976–1985). Int J Radiat Oncol Biol Phys 1992; 24: 441–449.PubMedGoogle Scholar
  27. 27.
    Optenberg SA, Thompson IM, Friedrichs P, Wojcik B, Stein CR, Kramer B. Race, treatment, and long-term survival from prostate cancer in an equal-access medical care delivery system. JAMA 1995; 274:1599–1605.PubMedCrossRefGoogle Scholar
  28. 28.
    Fowler JE, Terrell F. Survival in blacks and whites after treatment for localized prostate cancer. J Urol 1996; 156: 133–136.PubMedCrossRefGoogle Scholar
  29. 29.
    Moul JW, Douglas TH, McCarthy WF, McLeod DG. Black race is an adverse prognostic factor for prostate cancer recurrence following radical prostatectomy in an equal access health care setting. J Urol 1996; 155: 1667–1673.PubMedCrossRefGoogle Scholar
  30. 30.
    Consensus Development Panel. Consensus development conference on the management of clinically localized prostate cancer. NCI Monog 1988; 7: 3–6.Google Scholar
  31. 31.
    Whitmore WF. Localized prostatic cancer: management and detection issues. Lancet 1994; 334: 1263–1267.CrossRefGoogle Scholar
  32. 32.
    Harlan L, Brawley O, Pommerenke F, Wali P, Kramer B. Geographic, age, and racial variation in the treatment of local/regional carcinoma of the prostate. J Clin Oncol 1995; 13: 93–100.PubMedGoogle Scholar
  33. 33.
    Demers RY, Swanson GM, Weiss LK, Kau TY. Increasing incidence of cancer of the prostate. The experience of Black and White men in the Detroit metropolitan area. Arch Intern Med 1994; 154: 1211–1216.PubMedCrossRefGoogle Scholar
  34. 34.
    Liu WL, Kasl S, Flanery JT, Undo A, Dubrow R. The accuracy of prostate cancer staging in a population-based tumor registry and its impact on the Black-White stage difference (Connecticut, United States). Cancer Causes & Control 1995; 6: 425–430.CrossRefGoogle Scholar
  35. 35.
    Powell IJ, Schwartz K, Hussain M. Removal of the financial barrier to health care: does it impact on prostate cancer at presentation and survival? A comparative study between Black and White men in a Veterans Affairs system. Urology 1995; 46: 825–830.PubMedCrossRefGoogle Scholar
  36. 36.
    Desch CE, Penberthy L, Newschaffer CJ, Hillner BE, Whittemore M, McClish D, Smith TJ, Retchin SM. Factors that determine the treatment for local and regional prostate cancer. Med Care 1996; 34: 152–162.PubMedCrossRefGoogle Scholar
  37. 37.
    Schapira MM, McAuliffe TL, Nattinger AB. Treatment of localized prostate cancer in African-American compared with Caucasian men. Less use of aggressive therapy for comparable disease. Med Care 1995; 33: 1079–1088.PubMedCrossRefGoogle Scholar
  38. 38.
    Mettlin C, Murphy GP, Menck H. Trends in treatment of localized prostate cancer by radical prostatectomy: observations from the Commission on Cancer national cancer database, 1985–1990. Urology 1994; 43: 488–492.PubMedCrossRefGoogle Scholar
  39. 39.
    Brawn PN, Johnson EH, Kuhl DL, Riggs MW, Speights VO, Johnson CF, Pandya PP, Lind MI, Bell NF. Stage of presentation and survival of white and black patients with prostate carcinoma. Cancer 1993; 70: 2569–2573.CrossRefGoogle Scholar
  40. 40.
    Fleming C, Wasson JH, Albertsen PC, Barry MJ, Wennberg JE for the Prostate Patient Outcomes Research Team. A decision analysis of alternative treatment strategies for clinically localized prostate cancer. JAMA 1993; 269: 2650–2658.PubMedCrossRefGoogle Scholar
  41. 41.
    Demark-Wahnefried, W, Strigo T, Catoe K, Conaway M, Brunetti M, Rimer BK, Robertson CN. Knowledge, beliefs, and prior screening behavior among Blacks and Whites reporting for prostate cancer screening. Urology 1995; 46:346–351.PubMedCrossRefGoogle Scholar
  42. 42.
    Price JH, Colvin TL, Smith D. Prostate cancer: Perceptions of African-American males. J Natl Med Assoc 1993; 85: 941–947.PubMedGoogle Scholar
  43. 43.
    Price JH, Desmond SM, Wallace M, Smith D, Stewart PW. Black American’s perceptions of cancer: A study utilizing the Health Belief Model. J Natl Med Assoc 1988; 80: 1297–1304.PubMedGoogle Scholar
  44. 44.
    Gee WF, Holtgrewe HL, Albertsen PC, Litwin MS, Manyak MJ, O’Leary MP, Painter MR. Practice trends in the diagnosis and management of prostate cancer in the United States. J Urol 1995; 154: 207–208.PubMedCrossRefGoogle Scholar
  45. 45.
    Mort EA, Weissman JS, Epstein AM. Physician discretion and racial variation in the use of surgical procedures. Arch Intern Med 1994; 154:761–767.PubMedCrossRefGoogle Scholar
  46. 46.
    Ruffer JE, Epstein BE, Peters T, Hanks G. Lower radiation dose may account for decreased survival of blacks with prostate cancer: results of the 1978 Patterns of Care Study. Int J Radiat Oncol Biol Phys 1991; 21:212 (Abstract).Google Scholar
  47. 47.
    Morton RA. Racial differences in adenocarcinoma of the prostate in North American men. Urology 1994; 44: 637–645.PubMedCrossRefGoogle Scholar
  48. 48.
    Nomura AMY, Kolonel LN. Prostate cancer: A current perspective. Epidemiol Rev 1991; 13: 200–227.PubMedGoogle Scholar
  49. 49.
    Dayal HH, Polissar L, Dahlberg S. Race, socioeconomic status, and prostatic cancer. J Natl Cancer Inst 1985; 74: 1001–1006.PubMedGoogle Scholar
  50. 50.
    Dayal HH, Chiu C. Factors associated with racial differences in survival for prostatic carcinoma. J Chronic Dis 1982; 35: 553–560.PubMedCrossRefGoogle Scholar
  51. 51.
    Ernster VL, Selvin S, Sacks ST, Austin DF, Brown SM, Winkelstein W. Prostatic cancer: mortality and incidence rates by race and social class. Am J Epidemiol 1978; 107: 311–320.PubMedGoogle Scholar
  52. 52.
    Whittemore AS, Keller JB, Betensky R. Low-grade, latent prostate cancer volume: Predictor of clinical cancer incidence? J Natl Cancer Inst 1981; 83: 1231–1235.CrossRefGoogle Scholar
  53. 53.
    Guileyardo JM, Johnson WD, Welsh RA, Akazaki K, Correa P. Prevalence of latent prostate carcinoma in two U.S. populations. J Natl Cancer Inst 1980; 65: 311–316.PubMedGoogle Scholar
  54. 54.
    Kirscht JP. The health belief model and illness behavior. Health Educ Monog 1974; 2: 387–408.Google Scholar
  55. 55.
    Jette AM, Cummings KM, Brock BM, Phelps MC, Nassens J. The structure and reliability of health belief indices. Health Serv Res 1981; 16: 262–267.Google Scholar
  56. 56.
    Weissfeld JL, Brock BM, Kirscht JP, Hawthorne VM. Reliability of health belief indexes: Confirmatory factor analysis in sex, race, and age groups. Health Serv Res 1987; 21: 777–793.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Ronnie D. Horner
    • 1
  1. 1.Durham VA Medical Center Division of General Internal MedicineDuke University Medical CenterDurham

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