The COVID-19 pandemic has resulted in harmful barriers to care for patients living with or at risk for prostate cancer and has exacerbated many of the underlying health disparities affecting communities of color. President Joe Biden recently announced plans to improve access to health care, including reopening enrollment on the federal health insurance exchange. However, more must be done.
As the administration seeks to improve health equity and address the health disparities that disproportionately impact under-resourced and racial and ethnic communities, it must focus on increasing access to prostate cancer care and screening for Black men.
Prostate cancer is the second most common cancer among men. However, it is the leading cause of cancer for Black men, who are more than twice as likely to get and die from prostate cancer than white men. The disparate impact of prostate cancer on Black men is driven in part by health injustices that are pervasive across all health care services, and which have been magnified by the COVID-19 pandemic.
Recent research from the University of Michigan has shown that external factors, like access to quality health care and insurance, are key drivers of the disparity. Black men are over twice as likely to die from prostate cancer compared to white men and they are also more likely to be diagnosed at an advanced stage. Self-reported screening rates among Black men are slightly lower (33 percent) than what is observed in white men (37 percent) and shared decision-making is often lacking. Just as important as screening is the interpretation of results so that men can receive appropriate treatment.
In addition, clinical trials and studies have historically underrepresented people of color, which contributes to the lack of knowledge around the impact of prostate cancer on Black men. On top of these factors are other chronic illnesses and comorbidities that disproportionately impact communities of color and the socio-economic considerations that perpetuate systemic injustices.
Unfortunately, since the onset of the COVID-19 pandemic, these health disparities have only worsened. At the start of the pandemic, it was recommended that patients postpone appointments and treatments for non-emergent health issues, and many prostate cancer providers switched to offer telehealth services. While in the short term this was a strong strategy to mitigate the immediate impact of the pandemic on health care systems, as the pandemic continues, at-risk prostate cancer patients must be able to access the preventative care they need.
Furthermore, the COVID-19 pandemic has left millions of Americans unemployed and without health insurance. The negative socio-economic and health repercussions of the pandemic are disproportionately affecting Black Americans, which will compound the current impact of prostate cancer on Black men.
The American Cancer Society estimates that there will be approximately 248,530 new cases of prostate cancer in 2021, an alarming 30 percent increase over 2020, and with the delay in treatment caused by the global pandemic, the United States is behind on identifying at-risk men and getting care to African American men who are most at risk.
Some prostate cancer researchers and providers have also warned that as a result of delayed care due to the pandemic, we can expect to see greater rates of prostate cancer morbidity and mortality in the years to come. The delay in treatment is likely to exacerbate the disparate impact of prostate cancer on Black men.
As the Biden administration begins dismantling the systemic injustices that contribute to the health disparities impacting the Black community, the top priority should be to increase access to quality health care. Creating a special enrollment period for health insurance coverage in federal health insurance exchanges is a positive first step, along with committing to support and expand the Affordable Care Act. However, simply increasing access to health insurance is not enough.
In its efforts to work toward health equity, the administration should ensure that those most at risk for prostate cancer can access quality health services, including PSA screening with interpretation and other testing as appropriate. Federally regulated insurance plans should also increase coverage of treatments and medicines that are vital in the fight against prostate cancer. And lastly, the administration should provide additional resources for increasing the education and awareness of prostate cancer in at-risk populations.
While the Biden administration tackles the COVID-19 pandemic, there is a clear opportunity to address the negative repercussions of the pandemic on Black men. That’s why I’m working with the American Cancer Society Cancer Action Network, the American Urological Association, the Prostate Conditions Education Council, and ZERO – The End of Prostate Cancer to urge the Biden administration to increase access to quality prostate cancer health care in the fight toward health equity. If barriers to prostate cancer care are not addressed, it will result in greater health expenditures in the future and worse health outcomes for Black men, while worsening current health disparities.
Thomas Farrington is the president and founder of the Prostate Health Education Network and a prostate cancer survivor.
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