I have written past blogs about physical factors that increase the risk of dying from prostate cancer: genetic history, exposure to toxic agents, alcohol abuse, smoking, too much red meat, precursor conditions such as high grade PIN and ASAP, etc. However, there’s another risk factor that does not occur within the body, but certainly affects a person’s health: economics. It seems intuitive that men from lower socioeconomic groups would have higher death rates from prostate cancer as they do from other diseases, but how much do we really know about this situation?
Two German researchers searched for pertinent published articles from the PubMed database, a huge index of biomedical and life science publications that meet stringent criteria. A search for materials from January 2005 to September 2014 yielded 330 potentially eligible articles, which were further filtered down to 46. The authors found that the majority of the articles demonstrated a statistically significant connection between low economic status and higher rates of PCa-caused mortality. However, it was almost impossible to pinpoint causal factors. According to the article, “Several patient, disease and health care related factors are discussed…but evidence is still insufficient.”[i] In other words, there is no well-demonstrated explanation for why prostate cancer patients closer to the poverty level fare worse than their more fortunate brothers.
When I think about unequal access to medical care, I consider lack of PCa awareness, low rates of early detection, and lack of health insurance to cover the costs of diagnosis and treatment. It also stands to reason that lower socioeconomic status would carry with it higher rates of all the other risk factors for prostate cancer, such as poor diet and toxic exposure. It seems tragic that for those under economic hardship, a disease so curable would progress undiagnosed, and lead to a painful death. It’s true that many PCa cases that are detected through screening end up being overtreated, but I wonder if that’s more true of the upper and middle classes than the lower class.
I applaud the organizations, programs, churches, volunteers and many, many more who put great effort into getting screening into our inner cities and poor rural areas. I am grateful for foundations and fundraisers that generate resources to make excellent medical care available to even the poorest prostate cancer patient. I hope that wise minds are tackling this problem, and hastening the day when economic disparities in medical care begin to fade away. We have enough prostate cancer risk factors without adding financial circumstances to the list.