Prostate Cancer: Social, Economic and Demographic Correlates of Non Use of Supplemental Diets among Black Men in Florida

Background: Epidemiologic data consistently show that Black men in the U.S. are disproportionately affected by prostate cancer. The incidence rate is 60% higher and death rate is 2.1 times more for Black men compared to Whites. There is growing evidence from literature that nutritional supplements, such as selenium, lycopene, vitamin A, vitamin D and soy may reduce the risk of prostate cancer. However, the level of knowledge and usage of these supplemental diets among Black men is low. Therefore, it is important to understand why Black men are low users of the supplemental diets and develop intervention programs to change the underlining conditions. Objectives: Data collected in the state of Florida on prostate cancer disparities show that large proportion of Black men living in the state are nonusers of the supplemental diets. The purpose of this study is to identify socio-economic characteristics of U.S. born and foreign born Black men who are nonusers of the supplemental diets. Methods: A cross-sectional survey was conducted on prostate cancer disparity among Black men in five major cities in the State of Florida. Three thousand four hundred and ten valid respondents were included in the analysis. The main outcomes were socio-economic status, access to health care and awareness among Black men in relation to the use of supplemental diets that reduce the risk of prostate cancer. Descriptive statistics and zero-inflated regression models were used for data analysis. Results: The odds of nonuse of the supplemental diets were the highest for African born (Vitamin A OR = 2.32, P-value = 0.0060), for those who pray or do nothing when sick (Vitamin A OR = 2.84, P-value = 0.0367), with no insurance (Selenium OR = 1.32, P-value = 0.0007), and with no regular doctor to visit for medical care (Vitamin A OR = 1.29, P-value = 0.0318). Conclusion: The study data indicates that the usage of supplemental diets among Black men in Florida is very low. The study further provides rich data with regard to demographic characteristics for U.S. born and foreign born Black men that might serve to inform the usage of supplemental diets that may reduce the risk of prostate cancer

Area-level factors associated with spatial variation of prostate cancer incidence for black men

Purpose: Black men are disproportionately affected by prostate cancer (CaP) compared to any other racial/ethnic groups within the United States. Identifying CaP hotspots along with associated local area-level risk factors is crucial to tackling the significant burden of CaP and the disparity seen in Black men. The objective of this study was to determine the scope of geographical variation in CaP incidences and to assess the degree to which this variation is associated with county-level risk and protective factors.Methods: The study population was Black men diagnosed with prostate cancer between 2006-2010 in Florida. County-level CaP incidence rates were computed as the ratios of the numbers of new CaP cases diagnosed between 2006 and 2010 to the corresponding 2000 US census population of Black men 20 and over years old data (US Census 2000). Other county-level environmental and health care factors were also obtained. A random effects Poisson model and Geographical Information System (GIS) were used to map and assess the spatial patterns of CaP incidences in 67 Florida counties. These statistical techniques involved a Bayesian approach for estimating the underlying county-specific CaP risk since the data are very sparse.Results: The findings showed that an increasing CaP incidence of Black Men in Florida  was significantly associated with an increasing unemployment rate ( 2     with 95% CI: (.0025, .2703), does not include zero suggesting significance) and with increasing number of physicians per capita after controlling for other county characteristics. There was a negative association between poverty and CaP incidence. Regarding spatial distribution of CaP incidence, we observed that there are clustering and hotspots of high CaP incidence rates in Palm Beach county in South Florida, and Alachua and Marion counties in north Florida.Conclusion: Our findings showed that indicators of socioeconomic status and accessibility of health care services such as poverty, unemployment and health care providers are important variables that explain spatial variation of prostate cancer incidence rates of Black Men. Better understanding of such risk factors and identifying specific counties with a disproportionate burden of CaP disease may help formulate targeted interventions and resource allocation by state and local public official

Perceptions of Prostate Cancer Fatalism and Screening Behavior Between United States-Born and Caribbean-Born Black Males

Cancer fatalism is believed to be a major barrier for cancer screening in Black males. Therefore, the purpose of this study was to compare perceptions of prostate cancer (CaP) fatalism and predictors of CaP screening with Prostate Specific Antigen (PSA) testing between U.S.-born and Caribbean-born Black males. The Powe Fatalism Inventory and the Personal Integrative Model of CaP Disparity Survey were used to collect the following data from males in South Florida. Multivariate logistic regression models were constructed to examine the statistically significant predictors of CaP screening. A total of 211 U.S.-born and Caribbean-born Black males between ages 39–75 were recruited. Nativity was not a significant predictor of CaP screening with PSA testing within the last year (Odds ratio [OR] = 0.80, 95 % confidence interval [CI] = 0.26, 2.48, p = 0.70). Overall, higher levels of CaP fatalism were not a significant predictor of CaP screening with PSA testing within the last year (OR = 1.37, 95 % CI = 0.48, 3.91, p = 0.56). The study results suggest that nativity did not influence CaP screening with PSA testing. However, further studies are needed to evaluate the association between CaP screening behavior and levels of CaP fatalism

Microarray comparison of prostate tumor gene expression in African-American and Caucasian American males: a pilot project study

African American Men are 65% more likely to develop prostate cancer and are twice as likely to die of prostate cancer, than are Caucasian American Males. The explanation for this glaring health disparity is still unknown; although a number of different plausible factors have been offered including genetic susceptibility and gene-environment interactions. We favor the hypothesis that altered gene expression plays a major role in the disparity observed in prostate cancer incidence and mortality between African American and Caucasian American Males. To discover genes or gene expression pattern(s) unique to African American or to Caucasian American Males that explain the observed prostate cancer health disparity in African American males, we conducted a micro array pilot project study that used prostate tumors with a Gleason score of 6. We compared gene expression profiling in tumors from African-American Males to prostate tumors in Caucasian American Males. A comparison of case-matched ratios revealed at least 67 statistically significant genes that met filtering criteria of at least +/- 4.0 fold change and p < 0.0001. Gene ontology terms prevalent in African American prostate tumor/normal ratios relative to Caucasian American prostate tumor/normal ratios included interleukins, progesterone signaling, Chromatin-mediated maintenance and myeloid dendritic cell proliferation. Functional in vitro assays are underway to determine roles that selected genes in these onotologies play in contributing to prostate cancer development and health disparity

Post‐diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme ( CUP Global) systematic literature review and meta‐analysis

The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta‐analysis on post‐diagnosis adiposity measures (body mass index [BMI], waist circumference, waist‐to‐hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random‐effects meta‐analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta‐analyses were possible for BMI and all‐cause mortality, colorectal cancer‐specific mortality, and cancer recurrence/disease‐free survival. Non‐linear meta‐analysis indicated a reverse J‐shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m2). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m2), namely 60% and 23% higher risk for all‐cause mortality; 95% and 26% for colorectal cancer‐specific mortality; and 37% and 24% for cancer recurrence/disease‐free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow‐up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity‐outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well‐designed observational studies and interventional trials are needed to provide further clarification

Post‐diagnosis dietary factors, supplement use and colorectal cancer prognosis: A Global Cancer Update Programme ( CUP Global) systematic literature review and meta‐analysis

The role of diet in colorectal cancer prognosis is not well understood and specific lifestyle recommendations are lacking. We searched for randomised controlled trials (RCTs) and longitudinal observational studies on post‐diagnosis dietary factors, supplement use and colorectal cancer survival outcomes in PubMed and Embase from inception until 28th February 2022. Random‐effects dose–response meta‐analyses were conducted when at least three studies had sufficient information. The evidence was interpreted and graded by the CUP Global independent Expert Committee on Cancer Survivorship and Expert Panel. Five RCTs and 35 observational studies were included (30,242 cases, over 8700 all‐cause and 2100 colorectal cancer deaths, 3700 progression, recurrence, or disease‐free events). Meta‐analyses, including 3–10 observational studies each, were conducted for: whole grains, nuts/peanuts, red and processed meat, dairy products, sugary drinks, artificially sweetened beverages, coffee, alcohol, dietary glycaemic load/index, insulin load/index, marine omega‐3 polyunsaturated fatty acids, supplemental calcium, circulating 25‐hydroxyvitamin D (25[OH]D) and all‐cause mortality; for alcohol, supplemental calcium, circulating 25(OH)D and colorectal cancer‐specific mortality; and for circulating 25(OH)D and recurrence/disease‐free survival. The overall evidence was graded as ‘limited’. The inverse associations between healthy dietary and/or lifestyle patterns (including diets that comprised plant‐based foods), whole grains, total, caffeinated, or decaffeinated coffee and all‐cause mortality and the positive associations between unhealthy dietary patterns, sugary drinks and all‐cause mortality provided ‘limited—suggestive’ evidence. All other exposure‐outcome associations provided ‘limited—no conclusion’ evidence. Additional, well‐conducted cohort studies and carefully designed RCTs are needed to develop specific lifestyle recommendations for colorectal cancer survivors

Post‐diagnosis physical activity and sedentary behaviour and colorectal cancer prognosis: A Global Cancer Update Programme ( CUP Global) systematic literature review and meta‐analysis

Low physical activity and high sedentary behaviour have been clearly linked with colorectal cancer development, yet data on their potential role in colorectal cancer survival is limited. Better characterisation of these relationships is needed for the development of post‐diagnosis physical activity and sedentary behaviour guidance for colorectal cancer survivors. We searched PubMed and Embase through 28 February 2022 for studies assessing post‐diagnosis physical activity, and/or sedentary behaviour in relation to all‐cause and cause‐specific mortality and recurrence after colorectal cancer diagnosis. Total and recreational physical activity were assessed overall and by frequency, duration, intensity, and volume using categorical, linear, and non‐linear dose–response random‐effects meta‐analyses. The Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel interpreted and graded the likelihood of causality. We identified 16 observational studies on 82,220 non‐overlapping patients from six countries. Physical activity was consistently inversely associated with colorectal cancer morbidity and mortality outcomes, with 13%–60% estimated reductions in risk. Sedentary behaviour was positively associated with all‐cause mortality. The evidence had methodological limitations including potential confounding, selection bias and reverse causation, coupled with a limited number of studies for most associations. The CUP Global Expert panel concluded limited‐suggestive evidence for recreational physical activity with all‐cause mortality and cancer recurrence. Total physical activity and its specific domains and dimensions, and sedentary behaviour were all graded as limited‐no conclusion for all outcomes. Future research should focus on randomised trials, while observational studies should obtain objective and repeated physical activity measures and better adjustment for confounders