Poverty, Screening, and Prostate Cancer
There are many factors that play a role in prostate cancer risk and diagnosis. Many of these also impact treatment and outcomes. Lower income and where a person lives (geography) may be 2 of these factors.
Social influences on health
Certain areas of the United States have higher poverty levels. This connects income and geography and leads to differences in prostate cancer experience. These are 2 of many social influences on health. These influences are aspects of our personal situations and surroundings that impact well-being. Other influences include housing, education, employment, social support and more.1
The impact of social influences
While these may not seem to be related to health, they have a big impact. For example, if a person does not have a job, they may live in a poorer neighborhood or unsafe housing. They may be exposed to more air pollution, rodents, roaches, or mold that can cause health problems. Those with lower income may also have high levels of stress. This can increase a person’s risk for chronic diseases and earlier death.1,2
People living in poverty are also more likely to smoke, use alcohol, and eat poorer diets. These can all play a role in overall well-being. Also, there are usually fewer doctors in poorer areas. This makes it hard to diagnose and treat health problems long-term.1,2
Social influences and prostate cancer
Social influences can impact a person’s health in big and small ways. They can lead to differences in the way people are treated for the same condition. Some groups may have worse overall outcomes because of this. This is called health disparities.
In prostate cancer, many experts think there are disparities in screening, stage at diagnosis, treatment, and outcomes based on social influences like income and geography.1,2
Screening and stage at diagnosis
Screening for prostate cancer can only occur in people who have access to healthcare. If a person lives in a poorer area without many doctors, they may not undergo screening as often as someone with easier access. People with lower income may also be less likely to have health insurance. These are all big factors in why poverty and screening for prostate cancer may go hand-in-hand.2,3
If a person does not get screened for prostate cancer and instead sees their doctor after symptoms have started, their prostate cancer may be more advanced. This may be the reason why those with higher income (and higher rates of screening) are diagnosed with more localized disease. Those with lower income are often diagnosed once their cancer has advanced or even spread (metastasized).2,3
However, some studies have found that higher income may increase a person’s risk of being diagnosed with prostate cancer. However, this may be due to the fact that more people in this group are being screened in the first place.2,3
Treatment and outcomes
Prostate cancer treatment and outcomes are also impacted by income and geography. Access to treatment and good follow-up care can vary based on how easy it is to get to a doctor.4
Treatments and tests are being developed for prostate cancer, but not everyone is using them. One study found that a new genetic test that helps predict what kinds of treatment a person’s cancer may respond to is not being used equally.4
In the study, areas with higher income, education, number of doctors, and rates of prostate cancer screening were using the test more than others. This could be related to the ability to pay for the test, insurance status, or access to doctors who are aware and feel comfortable using newer options.4
Even when the highest quality treatment options are available, people who live in areas with lower average income still have worse outcomes. In one study, people with several different types of cancer enrolled in clinical trials were followed. Even when all participants received the same standard of care, 5-year overall survival, time until cancer progression, and cancer-related survival were all worse for those from poorer geographic areas.2
However, the reasons for these differences are unclear. They may be due to poorer care after the clinical trial, chronic stress, or other factors. Regardless of the underlying cause (or multiple causes), people from poorer areas still had a major health disparity.2
What can be done?
Tackling social influences on health is a complicated issue. It requires many local changes, as well as at state and national levels. Finding ways to secure safe housing, increase access to healthcare, and reduce the cost of care are all important. Increasing screening rates among at-risk groups and connecting those who are diagnosed with good, long-term care are also key.
Many of these efforts will take time. Until then, it is helpful to be aware of social influences of health and how they impact prostate cancer diagnosis, treatment, and outcomes. Understanding the many factors that play a role in our health and doing our best to consider them can help improve well-being.
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