Spain Pamela, Carpenter William R, Talcott James A, Clark Jack A, Do Young Kyung, Hamilton Robert J, Galanko Joseph A, Jackman Anne, Godley Paul A
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27709-2194, USA.
Cancer. 2008 Oct 15;113(8):2180-7. doi: 10.1002/cncr.23801.
Prostate cancer (PrCA) is the most common cancer and the second leading cause of cancer death among US men. African American (AA) men remain at significantly greater risk of PrCA diagnosis and mortality than other men. Many factors contribute to the experienced disparities.
Guided by the Health Belief Model, the authors surveyed a population of AA and Caucasian men newly diagnosed with PrCA to describe racial differences in perceived risk of PrCA and to examine whether 1) perceived high risk predicts greater personal responsibility for prostate care; and 2) greater personal responsibility for prostate care predicts earlier, presymptomatic diagnosis. Multivariate general linear modeling was performed.
The authors found that men with a PrCA family history appreciated their increased risk, but AA men with a family history were less likely to appreciate their increased risk. Nevertheless, neither reporting a PrCA family history nor perceived increased risk significantly predicted screening and preventive behaviors. Furthermore, higher physician trust predicted increased likelihood to have regular prostate exams and screening, indicating that the racial differences in seeking prostate care may be mediated through physician trust. Expressed personal responsibility for screening and more frequent preventive behaviors were associated with more frequent screening diagnoses, fewer symptomatic diagnoses, and less frequent advanced cancers.
Together, these results indicate that appreciating greater risk for PrCA is not sufficient to ensure that men will intend, or be able, to act. Increased trust in physicians may be a useful, central marker that efforts to reduce disparities in access to medical care are succeeding.
前列腺癌（PrCA）是美国男性中最常见的癌症，也是癌症死亡的第二大原因。非裔美国（AA）男性被诊断出患有PrCA以及死亡的风险仍然显著高于其他男性。许多因素导致了这种明显的差异。
在健康信念模型的指导下，作者对一群新诊断出患有PrCA的非裔美国男性和白人男性进行了调查，以描述他们对PrCA感知风险的种族差异，并检验：1）感知到的高风险是否预示着对前列腺护理有更大的个人责任感；2）对前列腺护理有更大的个人责任感是否预示着更早期的、症状前的诊断。进行了多变量一般线性建模。
作者发现，有PrCA家族病史的男性意识到了他们风险的增加，但有家族病史的非裔美国男性不太可能意识到他们风险的增加。然而，报告有PrCA家族病史和感知到的风险增加都没有显著预测筛查和预防行为。此外，对医生的更高信任预示着进行定期前列腺检查和筛查的可能性增加，这表明在寻求前列腺护理方面的种族差异可能通过对医生的信任来调节。对筛查表达的个人责任感以及更频繁的预防行为与更频繁的筛查诊断、更少的症状性诊断和更少的晚期癌症相关。
总之，这些结果表明，意识到患PrCA的风险更高并不足以确保男性有意愿或有能力采取行动。对医生信任的增加可能是一个有用的核心指标，表明在减少医疗保健获取方面的差异所做的努力正在取得成功。
