BLACK-WHITE DIFFERENCES IN THE STAGE AT PRESENTATION OF PROSTATE-CANCER IN THE DISTRICT-OF-COLUMBIA

Objectives. Prostate cancer (PC) is a major health problem for America n black males. Blacks experience higher PC incidence and mortality com pared to whites. Although the racial difference in PC incidence remain s unexplained, the difference in PC mortality has been largely attribu ted to the late stage of disease at presentation. By using the inciden ce data on District of Columbia residents, this study compares the sta ge at diagnosis between black men and white men and attempts to determ ine if observed differences may be attributed to socioeconomic status (SES). Methods. Reporting facilities staged PC using the Surveillance, Epidemiology, and End Results summary staging scheme. Averages of hig h school education, income, and home ownership at the census tract lev el were used as proxies for SES, and frequency distributions were repo rted. Data were stratified based on stage to examine the influence of race and SES on stage. Results. For 1987 to 1991, 980 men (median age, 71 years) were reportedly diagnosed with PC. Black patients are young er and prostate tumors appear more likely to be more aggressive among blacks than whites. SES is negatively associated with late stage PC, a nd currently married men, compared with previously married, are less l ikely to be diagnosed with metastatic PC. Black men are more likely to present with later stage disease, and this racial difference persists even when SES is controlled. Conclusions. Late stage diagnosis is ass ociated with favorable SES indicators. But substantial racial gradient s in the distribution of diagnostic stage persisted even after adjustm ent for SES. This suggests the need for more intensive efforts to addr ess issues related to access, quality, and utilization of cancer scree ning services as they pertain to all African-American men in the Distr ict of Columbia irrespective of their social status.