By Neil Armstrong
TORONTO, Ontario (Tuesday, April 18, 2023) — A new study that focused on the high incidence of prostate cancer among immigrants from Caribbean and West African countries in Ontario, is helping a Black men’s health advocacy group to raise awareness about the cancer.
The population-based research, led by Jamaica-born Dr. Aisha K Lofters, Dr. Jacqueline L. Bender and a team — including Anthony Henry and Kenneth Noel, Vice-president and President of The Walnut Foundation, respectively — found that in Ontario, the age-standardized incidence rate of prostate cancer, from 2008 to 2016, was consistently and significantly higher among immigrants from those countries than among other immigrants and long-term residents of the province.
“This data tells us what’s happening, but it can’t tell us what the cause is; there have been several theories that people have put forth. One is that it’s something genetic. Ultimately, many men, who come from the Caribbean — their ancestors came from West Africa — the same other region that we found, so is there something genetic that has to do with men, who are West African, that gives them a higher likelihood of developing prostate cancer?” Dr. Lofters, a scientist at Women’s College Research Institute, asked rhetorically.
She related that people have theorised it could be diet-related, so caused by elements of the Caribbean and West African diet; or it could be environmental exposures.
But, she added, the latter would be harder to explain, when there are men living here who are coming from two very different parts of the world. “Although we don’t know the reason, I would suspect that there is some genetic or biological component that’s explaining it for men from these two particular areas.
The physician, scientist, and associate professor at the University of Toronto says there are researchers, who are trying to figure out if there are specific genes that can be targeted to help them identify this, but more work is needed to be able to hone in, and determine, who is at higher risk, when talking about men coming from these regions.
She also noted that family history is a risk factor for prostate cancer, so it is very important for men to know their family history.
Dr. Lofters, who is the Chair in Implementation Science at the Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, says when men are having symptoms, such as a change in their stream, blood in their urine or unexplained weight loss, they should not ignore these as they could be a red flag.
She recommends going to see a doctor, where blood tests or a rectal exam can be done to determine if something is happening with the prostate.
The study has been published in the Canadian Medical Association Journal, presented at conferences and covered by the media to help raise awareness among men in the community; and for family doctors and primary care nurses to have their antennae raised, when dealing with men from the Caribbean and West African countries with such symptoms, to recognize that they might be a higher risk for prostate cancer.
The World Health Organization (WHO) statistics of global prostate cancer mortality, in 2020, indicate that Zimbabwe had the highest rate of prostate cancer mortality, followed by Barbados, and other Caribbean and African countries. Jamaica is ranked fifth on the list.
“What we find, here in Ontario, aligns with what the global statistics tell us about prostate cancer,” says Lofters, who alongside Dr. Bender, is working with The Walnut Foundation to understand the experiences of men diagnosed with prostate cancer in the healthcare system.
The organization, a men’s health interest and prostate support group, works with the Black community in identifying the needs of Black men in health and related issues.
“We have heard stories of men being dismissed, or not being provided the highest standards of care, when it comes to prostate cancer, so we really want to understand, are there systemic barriers in Canada’s healthcare system that could be improved upon for these men as they journey through the prostate cancer system? That’s one body of research that’s actively happening.”
The researchers also want to examine the Ontario data to see if there are differences, in terms of stage of diagnosis.
While the study examined the incidence of men just developing prostate cancer, the researchers also want to know if there were particular men, who were diagnosed later than others, because early diagnosis is better. They also want to understand other differences, in terms of survival. This is upcoming research that they are working jointly on with The Walnut Foundation.
Henry says the study helps to inform the Foundation, which is dealing with Black men, who are impacted, and he underscored the importance of men doing their prostate-specific antigen (PSA) tests and digital exams earlier — at age 40, instead of 50.
“My father died from this thing at 68, so my brother and I started monitoring at 40. Luckily for us, we had medical practitioners, who understood the issue and were in agreement to say, hey, you guys should start testing from then,” says Henry, whose cancer was caught at age 54, and his brother’s at 57, just from monitoring.
He says if men are monitored early enough and prostate cancer is detected, they have a fighting chance. However, if they pretend that there is no issue or wait around until 50, they might be in for a rude awakening.
The membership of the Foundation is predominantly Caribbean, so it will outreach to men from West African countries and also native-born Black men.
The vice president says this study is only the first step, and the Foundation can now approach policymakers and the medical establishment to act on its findings. It is also an opportunity to start dialogues with community health centres that are dealing with Black patients.
Henry expressed concern that the Ontario Health Insurance Plan (OHIP) does not cover the PSA test, which means that most men will have to pay $40 for it. Some doctors may check off a box to indicate that a man has to get the PSA done and that it is covered because they are from a high-risk group.
The Princess Margaret Hospital and The Walnut Foundation are collaborating on a genetics study, in partnership with some community health centres, that will examine samples from Black men, who died, to ascertain whether there is any gene commonality.
TAIBU Community Health Centre and the Foundation are also collaborating on a video project to educate the community.
A couple of events took place, last month, in partnership with the Jamaican Canadian Association to educate the community.
On June 3, the Foundation will have its ninth annual walkathon — led by honorary Chair, Ivan Dawns, political director of the International Union of Painters — to tap into the Union Movement to spread awareness.
Henry says Black men have asked the Foundation if there were any urologists from the Black community to whom they could be referred, but he could only think of one in the Greater Toronto Area — Dr. Emmanuel Abara, who is based in Richmond Hill, Ontario.
To address this, the organization has set aside $26,000 from last year’s walkathon to set up an endowment for medical students at the University of Toronto, with the hope that some will choose urology that could lead to improvement in health outcomes for the Black community.
“We need this type of research, I think, that does not look at the entire population as being homogenous, but recognizes that there might be different ethnic and racial groups that are at higher or lower risk of particular conditions,” says Dr. Lofters; adding that will allow personalized medicine and the highest quality of care to be provided.