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(CNN) — Nate Battle said he had avoided doctor’s visits for most of his life until 2014, when his insurance company began incentivizing preventive health screenings.
Battle, who is Black and was 49 at the time, said he made an appointment, thinking it would be routine and harmless. But the results from a prostate-specific antigen (PSA) test led to a series of other procedures that ultimately revealed Battle had aggressive prostate cancer.
Battle told CNN that he was able to have his prostate removed and that he’s thankful the cancer was caught early.
“At my follow-up appointment the doctor said, ‘You had another six months before things were going to get really bad for you,’” Battle recalled. “That was really scary to hear.”
One in six Black men will develop prostate cancer in their lifetime, according to the advocacy organization ZERO Prostate Cancer. Research from the American Cancer Society shows Black men are more than twice as likely to die from the disease than their White counterparts.
The stark racial disparity has spurred health advocates like Battle to sound the alarm and urge Black men to consider getting prostate cancer screenings.
The rate of prostate cancer among Black men has been underscored in recent weeks as Dexter King, the youngest son of the Rev. Martin Luther King Jr., died after a battle with prostate cancer. And in December, U.S. Defense Secretary Lloyd Austin underwent a prostatectomy to treat prostate cancer that was discovered that same month.
Doctors and health advocates suggest the disparity in deaths results from a lack of access to quality health care in many Black communities, mistrust and avoidance of the health care system, and the stigma surrounding the disease, which oftentimes means Black men aren’t discussing their diagnosis with other people.
These factors can also be barriers to screening, doctors say.
According to the American Cancer Society, “having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease,” but the disease is easier to treat when it’s diagnosed at an earlier stage.
Dr. Otis Brawley, professor of oncology and epidemiology at Johns Hopkins University, said the death rates among Black men are also higher because health care facilities in marginalized Black and Brown communities often have doctors with less training and fewer resources for providing high-quality care. Low-income people, he added, are also less likely to seek health screenings because of the associated costs.
“If you take Black men and White men who are stage II and give them equal treatment, you end up with equal outcome and equal prognosis,” Brawley said. “If you remove the insurance issues, social issues, racism issues and give everybody equal quality of care, you end up with equal outcomes.”
Fighting the Stigma
Brawley said there is also a stigma surrounding the digital rectal examination, which requires that a health care provider insert a gloved finger into a man’s rectum to feel the prostate for abnormalities.
Brawley said many of his Black patients have refused to go through with that procedure.
In 2021, Brawley was part of a team at Johns Hopkins that launched the Schaufeld Program for Prostate Cancer in Black Men, which travels to barbershops in the Baltimore and Washington, D.C., areas, to raise awareness about prostate cancer and screening in Black communities.
“A lot of men in their 30s and 40s don’t even know what the prostate is, or where it is,” Brawley said. “We want them to know (screening) is available, and we want them to understand that we are respecting their choice.”
Courtney Bugler, president and CEO of ZERO Prostate Cancer, said she has spoken with some Black men who had no idea they had a family history of prostate cancer because no one ever discussed it.
“What we find is, because men are not always interacting with their health care providers in a regular fashion and because they don’t realize they are at risk for the disease, they don’t know to be more vigilant,” she said.
ZERO Prostate Cancer has spent more than two decades working to raise awareness of the disease. Bugler said the organization is also lobbying Congress to pass the PSA Screening for High Risk Insured Men Act. The measure would require health insurance companies to offer prostate-specific antigen screenings for Black men or men between ages 55 and 69 who have a family history of prostate cancer without copays, deductibles or co-insurance.
Bugler said ZERO Prostate Cancer recommends that Black men start talking to their doctors about the risks and benefits of prostate cancer screening at the age of 40. She also encourages them to share their stories of survival with one another.
Although Battle knew that there were men in his family with the disease, he said he still refused to go to the doctor for years. He blames toxic masculinity and stubbornness, which he said can also play a role in preventing Black men from getting screened for prostate cancer.
“It’s ingrained in us that we are supposed to be strong,” Battle said.
But this mindset is only contributing to the high prostate cancer death rates in the Black community, Battle said.
“It’s about putting your pride aside,” Battle said. “And asking yourself: Is your pride more important than your life?”
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