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Equity vs. Equality

While equity and equality are often used interchangeably, equality and equity do not mean the same thing. Equality means everyone is treated the same regardless of differences in needs; but Equity recognizes that we might have different needs and suggests that resources and opportunities should be allocated based on those needs. This distinction is essential for prostate cancer because not everyone starts the prostate cancer journey with the same level or types of conditions. Given that fact, to ensure that we can zero our prostate cancer for everyone we must approach this effort with the goal of achieving health equity.

At ZERO, we define health equity as everyone having a fair and just opportunity to prevent, find, treat, and survive prostate cancer, regardless of race, sexual orientation, financial resources, physical abilities, or area of residence. This aspiration informs everything that ZERO does in empowering every person who is affected by prostate cancer.

Difference between equality and equity

In the same way a fence can block the field of view for some people, there are several barriers that make it harder for many looking for prostate cancer help and treatment. In the past, giving equal healthcare access to everyone was thought of as the best way to tackle those barriers. However, not every person benefits from the same support. Also, some people have different or more difficult situations and need different support in order to have the same access.

Equity, Equality, Liberation, and Inclusion

But only giving different support is not enough to address the cause of these issues: the fence, so to speak. Prostate cancer care needs to be equitable for Black men, people of color, and other vulnerable communities seeking help. To do that, the healthcare system itself has to be changed and the fences have to be removed. By doing so, every person affected by prostate cancer will have fair and just treatment. Everyone will be included in current and future efforts to prevent, find, treat, and survive prostate cancer.

Efforts to achieve health equity attempt to ensure that all groups managing a prostate cancer diagnosis, but especially those at greatest risk, achieve their best health possible. We work to get everyone on the prostate cancer journey what they need when they need it through our education, support, and advocacy efforts.

Racial Disparities in Prostate Cancer

The American Cancer Society (ACS) first began reporting on cancer disparities by race and socioeconomic status (SES) in the United States in 1986.[1] The report included multiple recommendations to mitigate these disparities, including increasing cancer prevention awareness and access to care.[2][3] Despite these recommendations, however, differences in mortality for all cancers combined and for primary cancers by race (Black vs. White people), SES, and rurality/urbanicity have increased since the publication of this report.

Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death in Black men in the United States. Not only are Black men more likely to get prostate cancer, but they are also more likely to be diagnosed with advanced disease than White men. Black men are 1.7 times more likely to be diagnosed with prostate cancer and 2.1 times more likely to die.

Black men get and die from prostate cancer at higher rates than other men.

Recent research suggests that these differences in health outcomes are likely caused by several factors within the U.S. healthcare system, including access to care, insurance status, racial biases, and distrust in the medical system – it cannot be solely explained by genetic differences.

Read more about Black men and Prostate Cancer

Lack of Diversity in the Healthcare System

Given that Black men have over 1.5 higher incidence of prostate cancer and over 2x higher mortality for this disease, we need more Black men as healthcare providers generally, and physicians specifically. However, “while Black male medical students accounted for 3.1% of the national medical student body in 1978, in 2019 they accounted for just 2.9%. Without the contribution of historically Black medical schools, just 2.4% would be Black men.” (source: https://www.statnews.com/2021/04/28/medical-schools-admitting-fewer-black-male-or-native-american-students).

Research has shown that when physicians and patients share the same race or ethnicity, shared decision making, patient understanding of cancer risk, treatment adherence is improved and implicit bias from the physician is decreased. (source: https://labblog.uofmhealth.org/rounds/Minority-patients-benefit-from-having-Minority-doctors-but-thats-a-hard-match-to-make-0)

Currently, only 2.1% of practicing urologists self-identify as Black/African American, and 2.3% of practicing oncologists self-identify as Black/African American. Increasing diversity among physicians caring for prostate cancer patients would enable patients to work with medical professionals who might better understand their cultural and social experiences, resulting in an improved overall patient experience, and genuinely meeting the needs of the variety of patients affected by prostate cancer.

Prostate Cancer Screening in Black Men

Due to the increased risk that some high-risk men face, prostate cancer screening guidelines in the United States have changed in recent years. The National Comprehensive Cancer Network (NCCN) recommends that Black men and individuals with a family history should begin having these conversations with their healthcare provider as early as age 40. These conversations should include a discussion of the risks and benefits of screening, the importance of the PSA blood test and the DRE (digital rectal exam), and the benefits of both tests in detecting prostate cancer.

Encouraging research shows that once diagnosed with prostate cancer, Black men have similar treatment outcomes as other men diagnosed at the same stage. This tells us that raising awareness of these early detection and screening guidelines may help reduce racial disparities in prostate cancer deaths and help diagnose prostate cancer in its earliest stages. Prostate cancer is 99% survivable if caught before it progresses, so early detection and access to quality healthcare are critical.

Advocating for the Prostate Cancer Community

ZERO leads a variety of advocacy efforts at both the federal and state levels. These range from prevention efforts aimed at the most high-risk men (e.g those with a family history, African American/Black men), increased research dollars specifically for prostate cancer and making prostate cancer screening accessible and affordable.

These efforts have clear results, including ongoing protection and expansion of the federal Prostate Cancer Research Program, state-level legislation requiring group health insurance plans to cover preventative screening costs, and a national movement within local governments to issue official recognitions about prostate cancer.

Racial Disparities in Prostate Cancer Citations

  1. [1] American Cancer Society. Special report on cancer in the economically disadvantaged. American Cancer Society subcommittee on cancer in the economically disadvantaged; 1986.
  2. [2] Freeman HP. Cancer in the socioeconomically disadvantaged. CA Cancer J Clin. 1989;39:266-288.
  3. [3] Freeman HP. Cancer in the economically disadvantaged. Cancer. 1989;64:324-334; discussion 342-325.
  4. [supplimental] Ma J, Jemal A. Temporal trends in mortality from major cancers by education in the United States, 2001-2016. JNCI Cancer Spectrum. 2019;3:pkz087. Garcia MC, Rossen LM, Bastian B, et al. Potentially excess deaths from the five leading causes of death in metropolitan and nonmetropolitan counties—United States, 2010-2017. MMWR Surveill Summ. 2019;68:1-11. Levit LA, Byatt L, Lyss AP, et al. Closing the rural cancer care gap: three institutional approaches. JCO Oncol Pract. 2020;16:422-430. Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004;54:78-93.

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