Each year, the month of September represents the start of a new season, a new school year, and a new beginning. It’s also a time to educate about a number of cancers through specific milestones – including Prostate Cancer Awareness Month.
As one of the most common types of cancers globally, prostate cancer is a deadly disease estimated to claim nearly 35,000 lives in the US this year alone.
While men, in general, are at risk of developing prostate cancer, the disease disproportionately affects men of color. In fact, prostate cancer is twice as likely to claim the lives of Black men compared to men of other races. US Veterans also face unique challenges when it comes to prostate cancer care, with an incidence rate that is twice that of the general population.
AstraZeneca is committed to amplifying voices from the community who are taking action to address these significant inequalities and educate about prostate cancer care, including patient advocacy organization ZERO – The End of Prostate Cancer.
To start the discussion, we connected with Shelby Moneer, Vice President of Programs and Education, and Reggie Tucker-Seeley, ZERO's Vice President of Health Equity. Read their unique takeaways on the gaps in care among underserved communities, the importance of biomarker testing and more.
A conversation with our allies at ZERO: The End of Prostate Cancer
1. Given the disproportionate impact that prostate cancer has on Black men, what should the community know about the role of genetic and biomarker testing after a prostate cancer diagnosis?
Black men are 1.8 times more likely to be diagnosed with, and 2 times more likely to die from, prostate cancer. Several factors are thought to influence these racial disparities, including access to care, racial biases, and family history, just to name a few.
There are two types of testing that are important to understand: genetic testing and biomarker testing. When we think about family history, we most often think about our extended family, but we also need to specifically consider the genes that are passed down to us directly from our parents. Genetic testing can help patients better understand not only their own prostate cancer diagnosis, but also whether their family members might be at increased risk.
Understanding if a patient’s cancer has any acquired mutations is also important. Acquired mutations are present in a tumor but are not passed down from a parent. Biomarker testing can identify these mutations and provide important information about how a patient’s tumor may behave. Treatments are available for men with certain inherited and acquired genetic mutations, so genetic and biomarker testing truly opens doors when it comes to making informed decisions about care.
VP of Programs and Education
Focus on Biomarkers
and Biomarker Testing
2. What is ZERO doing to reach underserved communities with information on biomarker testing?
Recently, ZERO formed a Racial Disparities in Prostate Cancer Task Force, made up of patients, caregivers, and healthcare providers to help bring more awareness of prostate cancer to men and families at the highest risk. The Task Force is focused on three pillars: education and awareness, clinical trial advocacy, and patient support.
In addition, in June of 2021, ZERO hosted its inaugural Racial Disparities in Prostate Cancer Symposium, providing a virtual learning and support opportunity to attendees. ZERO also launched a racial disparities in prostate cancer mini-site, with information, resources, and tools Black men can utilize to better understand their risk, as well as information like the importance of biomarker testing after a diagnosis. These include questions to ask your doctor, webinars, and website content created to overcome distrust in the healthcare system, and inform and empower prostate cancer patients.
3. How is ZERO supporting US Veterans?
ZERO is committed to ensuring that America’s protectors are fully equipped for the fight of their life - the fight against prostate cancer. This underscores the need for a clinical pathway to treatment in support of our veterans. Currently, there is not a single, comprehensive clinical pathway for prostate cancer in the Veterans Health Administration (VHA) to help guide care for men diagnosed with the disease – so ZERO is advocating to change this with the goal of helping to increase access to prostate cancer screening, diagnosis and treatment for veterans. Clinical pathways have been shown to improve patient outcomes, which could be game-changing for prostate cancer, the most commonly diagnosed solid tumor cancer in the VHA.
ZERO convenes the Veterans Prostate Cancer Working Group, a body of committed Veteran patients, caregivers, industry partners and experts in the prostate cancer and veterans communities. Our Veterans Champions help to disseminate prostate cancer education and resources to their communities, educating other veterans about their risk for prostate cancer and where they can turn for help if they are diagnosed and advocating for change.
4. Looking ahead, what makes you most hopeful about the future of prostate cancer care?
Advances in research and care related to biomarkers, targeted treatment, and precision medicine give me incredible hope for the future of care for prostate cancer patients. When care teams and patients understand each person’s cancer is unique, we can begin treating patients with the most appropriate and promising treatment options for their specific type of cancer. While the importance of early detection must never be overlooked, we know that treating the right patients with the right treatments at the right time can truly move the needle in prostate cancer care.
ZERO's Vice President
of Health Equity
1. After holding positions as an educator and public health researcher, can you share a bit of your background and what led you to your current role with ZERO?
Prior to joining ZERO, I was an Assistant Professor at the Leonard Davis School of Gerontology at the University of Southern California (USC). Before joining the faculty at USC, I was an Assistant Professor at the Dana-Farber Cancer Institute in the Center for Community Based Research and in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health. At Harvard, I developed and taught a course on measuring and reporting health disparities that was largely informed by my research on financial hardship and cancer, with a special focus on the reporting of health disparities. During the 2017-2018 academic year I was a Robert Wood Johnson Foundation Health Policy Fellow in Washington, DC.
My motivation for joining ZERO was influenced by the confluence of the age and racial/ethnic disparities highlighted during the COVID-19 pandemic, which encouraged me to think about how I could shift my work and focus on addressing racial/ethnic disparities in health. Given the substantial racial/ethnic disparities in prostate cancer, especially for Black men, this position at ZERO seemed like an amazing opportunity where my research and policy background, along with my lived experience, would be a great fit.
2. In what ways does prostate cancer affect Black men differently than others? What factors contribute to these disparities?
African American men have a substantially higher incidence rate for prostate cancer and are more likely to be diagnosed at younger ages. They also present with more advanced disease and have a two-three times higher mortality rate compared to non-Hispanic White men. These racial differences are explained by biological, social, environmental, and health care-related factors.
While what happens in the cancer care delivery system is critically important for men with prostate cancer, we must also look to what happens prior to entering care and what happens after care as context that contributes to differences in health outcomes across racial/ethnic groups for men managing prostate cancer. During the past year and half, there has been increased attention on disparities in our systems and how where we live, work and learn all influence our health. These factors influence access and quality related to prostate cancer screening, diagnosis, treatment, and survivorship.
Social determinants of health, which are also factors that may contribute to disparities, have been defined as the “conditions in which people are born, grow, live, work, and age.” Deprivation in those conditions can produce poor prostate cancer outcomes for men. It is the different levels of deprivation experienced across racial groups that create health/healthcare-related disparities.
3. Recognizing the health disparities in prostate cancer among men of color, where do we start when it comes to filling these gaps? How is ZERO working to address these challenges within the community?
It can be very challenging to know where to begin when attempting to address health disparities as they are often a result of processes that sort us into specific neighborhoods, occupations, and schools by race and socioeconomic resources. Therefore, it is important to have a strategy that not only views health disparities as a national issue, but a local one that is experienced by people navigating healthcare systems.
We have a dedicated section of our website that focuses on raising awareness of racial disparities in prostate cancer, increasing health education efforts focused on Black men, and ensuring that our great support programs are reaching Black men. I look forward to building on these efforts to ensure that health equity is the lens through which we implement all of our work at ZERO while also bringing into ZERO my own experiences in communities focused on consensus building in how we define certain terms related to equity and disparities in healthcare as we aim to address differences in outcomes.
4. How do social determinants play a role in access to prostate care?
Healthy People 2030, a project from the US Department of Health and Human Services (HHS), suggests that the social determinants of health can be grouped into five areas: neighborhood and built environment, healthcare access and quality, social and community contexts, education, and economic stability.
Deprivation in these areas can create or exacerbate social needs for patients as they are navigating prostate cancer care. If an individual with unstable housing, food insecurity, no access to transportation, or financial hardship is diagnosed with prostate cancer, he and his family must now also navigate a complex healthcare system, manage additional and unexpected care-related expenses, and consume difficult to digest healthcare information.
Without a functioning healthcare system and organizations in the community like ZERO to screen, navigate, and connect patients and their caregivers to services that address social needs such as food insecurity, transportation needs, or financial hardship, these patients and caregivers may struggle in managing and navigating prostate cancer care.
For more information on ZERO, visit their website at ZeroCancer.org.