4.7 Article

Racial disparities in prostate cancer: A complex interplay between socioeconomic inequities and genomics

Journal

CANCER LETTERS
Volume 531, Issue -, Pages 71-82

Publisher

ELSEVIER IRELAND LTD
DOI: 10.1016/j.canlet.2022.01.028

Keywords

African American; Outcomes; Androgen; DNA Damage; Inflammation; Tumor microenvironment; Social determinants

Categories

Funding

  1. National Institute of General Medical Sciences of the National Institutes of Health [T32GM136554, T32GM008231]
  2. Prostate Cancer Foundation
  3. National Cancer Institute [U54-CA233223]
  4. Department of Defense PCRP [IDA W81XWH-18-1-0288, PCRP HDRA W81XWH2110253]

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Prostate cancer has the largest health disparity in the US, with Black men having a significantly higher risk of dying from prostate cancer compared to other races. This disparity is influenced by factors such as socioeconomic status, environmental exposures, and genetics/biology. While improving healthcare access is important, it will not fully eliminate racial health disparities in prostate cancer outcomes. Biology also plays a crucial role, with significant differences observed in prostate cancer biology between ancestral groups.
The largest US cancer health disparity exists in prostate cancer, with Black men having more than a two-fold increased risk of dying from prostate cancer compared to all other races. This disparity is a result of a complex network of factors including socioeconomic status (SES), environmental exposures, and genetics/biology. Inequity in the US healthcare system has emerged as a major driver of disparity in prostate cancer outcomes and has raised concerns that the actual incidence rates may be higher than current estimates. However, emerging studies argue that equalizing healthcare access will not fully eliminate racial health disparities and highlight the important role of biology. Significant differences have been observed in prostate cancer biology between ancestral groups that may contribute to prostate cancer health disparities. Notably, relative to White men, Black men with prostate cancer exhibit increased androgen receptor signaling, genomic instability, metabolic dysregulation, and inflammatory and cytokine signaling. Immediate actions are needed to increase multi-center, interdisciplinary research to bridge the gap between social and biological determinants of prostate cancer health disparities.

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