Prostate cancer is mostly seen as a disease of older men. Yet about 10% of recent diagnoses occur in men age 55 or younger, and these early-onset cancers often have a worse prognosis. Biological differences partly explain the discrepancy. For example, early-onset prostate cancer comprises certain genetic abnormalities which are often not seen in older men with the disease.
But socio-economic aspects also play a very important role. New research by investigators on the Jacksonville College of Medicine (JCM) in Florida. The fact is that poverty, educational status, and other aspects controlling for socioeconomic status (SES) affect cancer survival.
This is the primary study to research how SES affects survival in early-onset prostate cancer. The results showed that men with low SES didn't survive so long as patients with high SES. “They are more likely to be diagnosed at advanced stages,” says Dr. Carlos Riveros, a physician and research associate at JCM and first creator of the paper.
What did the research find?
During the investigation, Dr. Riveros and his colleagues reviewed data from the National Cancer Database (NCD), which is sponsored by the American College of Surgeons and the National Cancer Institute. NCD receives data from greater than 1,500 hospitals within the United States. Dr. Riveros' team specifically focused on long-term consequence data from 112,563 men initially diagnosed with prostate cancer between 2004 and 2018.
The researchers were in a position to determine the zip codes where each of those patients lived. Then they checked out the per capita income for those zip codes, in addition to the share of individuals living inside them who had not yet earned a highschool diploma. Taken together, income and education data served as a composite SES measure for every zip code population. In a final step, the team checked out how survival rates for early-onset prostate cancer patients compared across zip codes.
The results were striking: Compared with high SES patients, low SES men were significantly more prone to be African American, and fewer prone to have medical insurance. Most men with low SES lived in rural areas and had stage IV prostate cancer at diagnosis. Low SES patients were treated at more advanced cancer centers, and fewer of those patients underwent surgical operation.
After adjusting for age, race, ethnicity, cancer stage, treatment, and other variables, low SES men were 1.5 times more prone to die than high SES men during a median follow-up of 79 months.
Observations and comments.
According to Dr. Riveros, the findings are consistent with evidence showing that social determinants of health — the conditions within the places where people work and live their lives — have broad effects on cancer risk. “Many people in low SES areas have had a poor diet since birth,” he says.
Dr. Riveros says that lower SES men could also be limited of their ability to search out, understand, or use health information, and subsequently “may not know what prostate cancer feels like.” happens, or when it's time to go to the doctor”. . He and his co-authors concluded that SES needs to be considered when implementing programs to enhance the management of patients with early-onset prostate cancer.