Epidemiologists have unexpectedly found that African Americans had a higher rate of recurrence following prostate cancer surgery than did whites, regardless of whether or not patients received surgery at hospitals or by surgeons who performed a high number of such operations.
The findings were surprising as previous research has shown that, in general, patients fare better at hospitals that perform a high volume of surgeries or by surgeons who perform a large number of operations.
According to epidemiologist Kyna Gooden, Ph.D., of Shaw University, previous studies have shown that African Americans have a higher rate of prostate cancer recurrence and a greater likelihood of dying from their cancer following prostate surgery ? more specifically, total removal of the prostate gland ? compared to white men.
She and her co-investigators at Shaw University and the University of North Carolina in Chapel Hill, looked at whether the number of prostate cancer surgeries a hospital or a surgeon performed affected this disparity.
Gooden and her team hypothesized that a disproportionate number of African Americans were treated at hospitals or by physicians performing fewer surgeries. The racial differences in the prostate cancer recurrence and mortality following surgery would disappear, they assumed, once they took into account hospital and physician volume.
They examined data from the Surveillance, Epidemiology, and End-Results Medicare database for 962 African American and 7,387 white men diagnosed with prostate cancer between 1993 and 1999 who had received surgery within six months of diagnosis. They controlled for age at diagnosis, cancer stage and grade.
When the researchers looked at the outcomes after surgery in relation to volume, results were similar to previous findings ? patients who had surgery at high volume hospitals for prostate cancer were less likely to have cancers that returned and less likely to die from prostate cancer. But when they broke down the numbers by race for African Americans and whites, they found that surprisingly, the racial disparities persisted.
“Even for patients who went to high volume hospitals and were seen by high volume physicians, there was still a racial disparity,” Gooden said. “We expected that if everyone was treated by similarly experienced doctors or hospitals, they would have had comparable outcomes. But that wasn’t the case.”
“These results may have less to do with access to clinical care but more to do with lifestyle factors and the physical and genetic characteristics of the tumor itself,” Gooden said.