The statistics regarding the disparity in prostate cancer rates among Black men are stark.

Black men are more likely to develop prostate cancer at younger ages and die of the disease at a rate 2.5 times higher than that of their white counterparts, according to the American Cancer Society. Data published in Cancer also indicates that Black men are 44%-75% more likely to present with advanced-stage prostate cancer.

The Mike Slive FoundationThe Mike Slive Foundation

Prostate cancer screening is key for early detection, early treatment and improved survival. However, prostate cancer screening rates among Black men are only about 37%. In response to these disparities, the Office of Community Outreach & Engagement at the O’Neal Comprehensive Cancer Center at UAB has partnered with the Mike Slive Foundation for Prostate Cancer Research on a study, called “Developing Culturally-Tailored Interventions to Increase Prostate Cancer Screening among African-American Men,” that seeks to better understand how to increase screening rates within this population.

“While there are likely many factors that contribute to the high disparity, one of our primary goals is to ensure is that African American men receive important information regarding age-appropriate screening and checkups to reduce that devastating rate,” said Monica Baskin, Ph.D., associate director for Community Outreach & Engagement at the O’Neal Comprehensive Cancer Center. “The Cancer Center has a longstanding commitment to researching health disparities. The investment by the Mike Slive Foundation has enabled us to advance even further in our mission and ensure that all men in our state receive the best care possible.”

The results of this study will be used to increase knowledge and develop culturally appropriate ways to increase prostate cancer screening rates among African American men between the ages of 35 and 70.

The Office of Community Outreach & Engagement conducted a series of surveys and interviews with 85 Black men in Jefferson, Butler, Macon and Dallas counties. The selection of counties gave researchers a mix of both rural and urban populations, with Jefferson County representing a large urban center.

Meghan Tipre, DrPHMeghan Tipre, DrPH

“We do have a good representation. For this kind of preliminary pilot study, it was a good number,” said Meghan Tipre, DrPH, a scientist from the Office of Community Outreach & Engagement.

Researchers were focused on understanding factors that encourage African American men to get screened for prostate cancer and on the factors that discouraged them. The study also included a Prostate Cancer Working Group, whose members served as advisors, while researchers developed questions and formed strategies to effectively communicate with audiences.

“The approach that we used was a systematic process of getting qualitative data from these participants,” Tipre explained. “We used the group concept mapping approach to find out what is preventing Black men from getting screened for prostate cancer.”

A second phase of the study involved telephone interviews with a few selected men and a spouse, partner, friend or close family member to find out what role close family members can play in influencing the men in their lives to undergo prostate cancer screening.

Overcoming pandemic challenges

The ongoing COVID-19 pandemic presented a unique challenge to researchers and coordinators. The team was forced to transform the program, which was initially set to be conducted in person, into a virtual-only initiative.

“There were a lot of challenges with that,” Tipre said. “While the majority of our participants had internet access, the coordinators had to consistently go back to them and encourage them to participate. That took some effort, it took some creativity and it took some persistence.”

Dale Bell, a coordinator in Dallas County, Alabama, also recalled the challenges associated with adapting the program for the pandemic.

Dale BellDale Bell

“Some of the guys are not really computer savvy, so it took a lot of corresponding back and forth and walking them through the process,” he said. “There were a couple of times where I had to make home visits and just be persistent when it came to the guys.”

Bell said establishing trust was essential.

“A topic such as prostate cancer is a sensitive subject. Once they felt comfortable with you and saw that you had their best interest at heart, they chimed in really well,” Bell said.

Tipre noted that these efforts were successful in developing strong participation and delivering quality data that was comparable to that of in-person data.

“We found that this virtual platform could work,” she said.

Tipre said there were unintended benefits of the virtual model as well. For example, participants were able to log on to their computers when it was convenient for them. They also had the anonymity to answer questions outside the traditional focus group setting.

Finding answers

The project resulted in a cluster map consisting of 41 unique statements and eight themes that answered the following question: “What are some of the issues, problems or concerns that African American men may have that prevent them from seeking prostate cancer screening?”

The themes included fear of the unknown, concern about showing weakness, dislike of the digital rectal exam, worry about the perceived loss of masculinity, lack of knowledge about screening, perception of low prostate cancer risk, denial or embarrassment, and concerns related to insurance or cost.

The men were also asked to suggest solutions, which included offering alternative methods to the digital rectal examination, early education, open discussions with others to break the taboo around digital rectal exams, clear and direct messaging, combining prostate cancer information with other health messaging, identifying relatable role models as messengers and involving family members in the discussion.

The feedback also resulted in the creation of a slogan: “Don’t wait until it's too late. Check your prostate.”

The study team from the Office of Community Outreach & Engagement is further analyzing the data. Tipre said the results already indicate the need to make prostate cancer discussions part of larger conversations about overall health.

Tipre said the O’Neal Cancer Center will also continue to work with the Mike Slive Foundation and other community partners to promote awareness and connect men to screening and care.

“This study is going to inform the next steps for intervention and what is going to be the approach to getting the messages out regarding prostate cancer,” she said.

This story originally ran in the September 2021 issue of Community Connections, the monthly newsletter of the Office of Community Outreach & Engagement at the O’Neal Comprehensive Cancer Center at UAB.