Disproportionate Effects of Prostate Cancer in Black Men: The ConDUC Initiative
By: Arthur L. Burnett, MD, MBA | Posted on: 01 Nov 2022
In the United States, men of African descent endure a disproportionately greater burden of prostate cancer relative to men of other ethnic groups. They are more likely to develop prostate cancer, develop a severe form of this disease, and encounter advanced disease when diagnosed, and they are more than twice as likely to die from prostate cancer than men of other ethnic groups.1 A host of factors are associated with these disparities. Biological disease and genetic mechanisms,2 social determinants of health spanning from socioeconomic status (income, education, and insurance level) to neighborhood/physical environment, community/social context, and geography,3,4 and also cultural/personal health beliefs5 have all been implicated as drivers of racial disparities in prostate cancer incidence and survival. Besides these disease- and patient-related conditions, health care provider–associated factors and structural (institutional and societal) prejudice/bias6 are also at play. Specifically, limited access to both common services as well as advances surrounding screening and diagnostic procedures and treatment7,8 constitute significant barriers contributing to inequities in prostate cancer outcomes. These disparities remain unaddressed and prompt a call for action.
In recognizing this unmet need, a group of urologists and professionals in business and academia established the Consortium on Disparities of Urologic Conditions (ConDUC) as a not-for-profit organization with a 501(c)3 designation in 2017. Collectively, they conceived this entity as serving to address health care disparities and improve adverse health outcomes related to urological diseases and associated conditions. ConDUC’s stated mission is to expand and accelerate scientific investigations of urological diseases and associated conditions that disproportionately affect the lives of peoples of color and, in so doing, develop actionable approaches for overcoming disparities. The initial focus of the organization has been to address health care disparities related to prostate cancer, and within this space several specific initiatives have been initiated.
Foremost, the organization has instituted a longitudinal, observational database comprising predominantly Black men with all stages of prostate cancer in diverse practice settings nationwide. This registry, branded SCOPE (Scientific Consortium on Prostate Cancer Education), emanated from the clear and discouraging observation that Black men comprise a small fraction of patients included in most existing large clinical registries and they are also sparsely represented in clinical research studies intended to investigate methods to improve the diagnosis, evaluation, and treatment of prostate cancer.9 In the absence of high-quality data inclusive of this cohort of men, it is evident that all efforts to understand the multiple variables of biology, socioeconomics, and access to health care impacting outcomes from prostate cancer and, moreover, to derive valid, actionable interventions for this disease are hampered.
Linked to this registry effort, ConDUC has also initiated plans for a biorepository for procuring prostate cancer tissue, along with blood and urine samples. This biorepository is viewed to offer a valuable resource for complementary biological and genetic studies in ethnic populations.
Central to its broad objectives, ConDUC has created a Scientific Review Committee to devise and implement a scientific plan. This committee is charged with formulating scientific programs and fostering research collaborations. An external advisory board has also been established to bring additional insights and guidance to the scientific operations of the organization.
Although early in its progress, ConDUC has begun holding prostate cancer scientific symposia thematically focused on addressing health disparities of this disease. An inaugural Prostate Cancer Symposium was held November 12-13, 2021, at Clark Atlanta University’s Center for Cancer Research and Therapeutic Development in Atlanta, Georgia. The meeting gathered urologists, research scientists, patient advocates, and partners from academia, the community, and the medical industry (Figure 1). The meeting was a ceremonial opening for ConDUC, during which its strategic plan was presented. A second Prostate Cancer Symposium will be held November 18-19, 2022, again hosted by Clark Atlanta University. The symposium, titled “Taking Action: Solutions over Soundbites,” is shaping up to be another momentous event (Figure 2). The event will officially mark the national launch of the SCOPE registry, demonstrating its platform for data capture and analysis. It will also feature scientific sessions, expert discussions, and student presentations. All are welcome to attend and participate. A word of special thanks is extended to the City of Hope (Cancer Treatment Centers of America) for its cosponsorship of this symposium.
The potential impact of ConDUC rests in its leadership, planning, and organization. This endeavor extends beyond the steady work of the Executive Committee* and benefits from the activity of committed advisors and collaborative partners. The registry enterprise, for instance, reflects a valuable collaboration with ArborMetrix, a corporation specializing in clinical data registry development. Our affiliation with Clark Atlanta University through its Center for Cancer Research and Therapeutic Development has enabled the organization to gain an authentic, strong foothold.
ConDUC is looking forward with excitement to achieving its long-term objectives. We appreciate all stakeholders–philanthropic humanitarians, clinical researchers, urologists, academic medical leaders, health care disparity experts, medical/pharmaceutical industry leaders, government officials, health care information data analysts, health care advocates and patients–who are actively engaging with us in the cause to achieve health care equity.
*Executive Committee: Walter Rayford, Robert Waterhouse, Curtis Pettaway, Randy Bradley, Arthur L. Burnett, Kelvin A. Moses, Jean Joseph, Brian Stone, and Michael Bivins.
For more information about ConDUC, contact Walter Rayford at firstname.lastname@example.org.
- DeSantis CE, Miller KD, Sauer AG, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin. 2019;69:211-233.
- Rebbeck TR. Prostate cancer genetics: variation by race, ethnicity, and geography. Semin Radiat Oncol. 2017;27: 3-10.
- Ziehr DR, Mahal BA, Aizer AA, et al. Income inequality and treatment of African American men with high-risk prostate cancer. Urol Oncol. 2015;33:18.e7-18.e13.
- Coughlin SS. A review of social determinants of prostate cancer risk, stage, and survival. Prostate Int. 2020;8:49-54.
- Kinlock BL, Parker LJ, Bowie JV, Howard DL, LaVeist TA, Thorpe RJ Jr. High levels of medical mistrust are associated with low quality of life among black and white men with prostate cancer. Cancer Control. 2017;24:72-77.
- Annie E. Casey Foundation. Race Equity and Inclusion Action Guide. Accessed September 9, 2022. https://www.aecf.org/resources
- Tehranifar P, Neugut AI, Phelan JC, et al. Medical advances and racial/ethnic disparities in cancer survival. Cancer Epidemiol Biomarkers Prev. 2009:18:2701-2708.
- Friedlander DF, Trinh QD, Krasnova A, et al. Racial disparity in delivering definitive therapy for intermediate/high-risk localized prostate cancer: the impact of facility features and socioeconomic characteristics. Eur Urol. 2018;73:445-451.
- Lillard JW Jr, Moses KA, Mahal BA, George DJ. Racial disparities in black men with prostate cancer: a literature review. Cancer. 2022;doi: 10.1002/cncr.34433.