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20.12.2014 Feature Article

Prostate Cancer: West African Men And The Trans-Atlantic Slave Trade, Any Connection With The High Incidence Rates?

Prostate Cancer: West African Men And The Trans-Atlantic Slave Trade, Any Connection With The High Incidence Rates?
20.12.2014 LISTEN

The Prostate cancer UK revealed that 1 in 4 black men will get prostate cancer in his lifetime and as cancer of the prostate is hitting black men than men of other race I decided to do a research on black men in the UK, Caribbean and others on why men of West Africa descent incidence have any potential connection with the Trans-Atlantic Slave Trade.

There are now mammon's of proof which can be traced back to the African transatlantic slave trade signifying that black men have a higher risk of prostate cancer compared to other ethnic groups. It has also been identified that however migration to Westernized countries may have had little effect on the incidence of prostate cancer in this ethnic group; nevertheless, present evidence directs that there are several multifaceted factors that may contribute to this risk. Studies in the UK quote that black men are at 2-3 times the risk of prostate cancer in comparison to their Caucasian counterparts, with a 30% higher mortality rate.

Care should therefore be taken prior to the interpretation of these results due to an insufficiency of research in this area, limited accurate ethnicity data, and lack of age-specific standardization for comparison. Cultural attitudes towards prostate cancer and health care in general may have a major impact on these figures, combined with other clinico-pathological associations. (Abeyna et al 2014)update reviews new contributory research on this subject, emphasizing the need to increase awareness and understanding of prostate cancer amongst high-risk communities and to support further vigorous research in this area by suggesting a lead in cancer and ethnicity studies within the National Health Service.

(Kleier et al 2003) alsoestablish such a link with black men and prostate cancer.While men of all racial and ethnic backgrounds are at risk, black men of African descent are at especially high risk. African-Caribbean men, particularly Jamaican men, have the highest rate of prostate cancer in the world. The term "African-American" has been used to describe all black people living in the US.

Use of such wide classification ignores the existence of subcultures within the black community. While members of the black race may share similar primary, genetic characteristics, skin color cannot be associated with attitudes, knowledge, and behaviors of particular cultural groups. So, prostate cancer interventions developed for African-American men may not be effective for men of African-Caribbean descent (Kleier et al 2003).

A study aim to evaluate research on knowledge and perceptions of Prostate cancer among Black men was done by Pedersen et al 2012). They study authors employed four medical and social science databases were systematically searched, and reference lists of relevant papers were hand searched. Non-English publications were excluded. Qualitative findings were synthesized using comparative thematic analysis to which quantitative findings were integrated.

They study authors found that individual, cultural and social factors likely to impact on Black men's awareness of, and willingness to be tested for, Prostate cancer. Black men's awareness of personal risk of Prostate cancer varied greatly between studies. Misunderstandings regarding methods of diagnosis and treatment were widespread. Prostate cancer testing and treatment were perceived as a threat to men's sense of masculinity.

Mistrust of the health-care system, limited access to health care and lack of trusting relationships with health professionals were also prominent. They therefore concluded that the factors impacting on Black men's awareness of Prostate cancer may contribute to late Prostate cancer diagnosis and should be taken into account when communicating with Black men seeking prostate care. Further, the review demonstrated a need for high-quality studies in countries other than the USA to determine the relevance of the review findings for Black men in other nations and continents.

According to Odedina et al 2009, This higher incidence of prostate cancer observed in populations of African descent may be attributed to the fact that these populations share ancestral genetic factors. To better understand the burden of prostate cancer among men of West African Ancestry, the study authors conducted a review of the literature on prostate cancer incidence, prevalence, and mortality in the countries connected by the Transatlantic Slave Trade.

In their result the authors realized several high prostate cancer burdens in Nigeria and Ghana but there was no published literature for the countries Benin, Gambia and Senegal.

To achieve the objective for their study, they conducted a literature review, summarizing the body of evidence on prostate cancer morbidity and mortality in countries with high population of Black men of West African ancestry, excluding the US. Their goal was not to provide a meta-analysis evaluation nor conduct a comprehensive review/critique of these studies. Their aim was to just examine the available proof in an effort to better understand the burden of prostate cancer among Black men of West African ancestry.

The study countries for their review were West African TAS populations (Benin, Nigeria, Ghana, Gambia, and Senegal), the United Kingdom and Caribbean Islands (Barbados, Cuba, Haiti, Dominican Republic, Netherlands Antilles, Trinidad and Tobago, Jamaica, and Brazil). A systematic search of the computerized database, MEDLINE, was conducted for each country from the originating date of MEDLINE to July 2008 using the following keywords: Black men, prostate cancer, prostate cancer risk, prostate cancer incidence; prostate cancer morbidity; and name of TAS country.

The study authors believed that the Trans-Atlantic Slave plays a role in the prostate cancer burdens in men of West African ancestry. According to the authors based on the TAS, about 15 million people were transported as slaves from Africa, not counting those who died en-route to the Americas, Caribbean and Europe. The TAS comprised the following three journeys: (Outward passage from Europe to Africa carrying manufactured goods; (2) Middle passage from Africa to the Americas/Caribbean carrying African captives and other commodities; and (3) homeward passages carrying sugar, tobacco, rum, rice, cotton and other goods back to Europe. These slave routes included diverse countries.

The European countries involved in the TAS were Portugal, France, Netherlands, Spain, Denmark, Norway and United Kingdom. Slaves were primarily imported from the African countries – Benin, Nigeria, Ghana, Gambia, Senegal, Mozambique, and Angola. The middle passage took the slaves from Africa to the American and Caribbean countries – Barbados, Cuba, Haiti, Dominican Republic, Netherlands Antilles, Trinidad and Tobago, Jamaica, Brazil, and the US. Most of the slaves ended up in South America or the Caribbean with about 500,000 transported to North America. Regrettably, most of the slaves in the Caribbean, Central America and South America died while the slave population in North America had higher life expectancy.

The constant higher incidence of prostate cancer relative to other groups, observed in populations of West African descent may be attributed to the fact that these populations share ancestral genetic factors that increase susceptibility to prostate cancer. Though, the likely inconsistency in risk across these populations of African men around the world may also suggest a possible and significant effect of environmental/lifestyle factors acting on prostate cancer risk in these susceptible populations. To date the disparate incidence of prostate cancer in African American men in the US compared to their Caucasian counterparts is poorly understood.

Although adjustable exposures related to lifestyle or environment is believed to play a major role in the etiology of prostate cancer, the specific causal factors remain indefinable. To identify these causal factors and to better understand and address the global prostate cancer disparities seen in Black men, it is important to differentiate genetic and environmental determinants of prostate cancer in men of West African ancestry, especially the original TAS source population for African American men.

As defined by Odedina, Ogunbiyi and Ukoli, even with the obtainable and developing data, there are more questions than answers at this time: Does the similar genetic characteristic of Black men of West African ancestry put them at higher risk for prostate cancer compared with other groups? Are there common environmental conditions/lifestyle factors among these men that may be responsible for the prostate cancer burden experienced by this group? What is the relative contribution of genetic, lifestyle and environmental factors in prostate cancer incidence and mortality among this group? The study authors report establishes and provides a clear need, in addition to defining the next steps, for a systematic and complete evaluation of these populations that can facilitate a better understanding of the etiology of unequal burden of this disease in African American men.

Prostate cancer in black men of African descent has a different tumour biology compared to those of other races. Its clinical manifestations depict a more aggressive disease with higher morbidity and mortality.

According to Robin Roberts (2014) whose study proposes, through a literature search, identifying applied laboratory and clinical research in prostate cancer directed to improve outcomes and decrease global disparities of prostate cancer in black men of African descent. This review identified five categories pertinent for research: prostate-specific antigen (PSA) testing for early detection and screening, the potential of epigenetics, cultural determinants and health-seeking behaviours, other biomarkers for prostate cancers, and the economics of treating advanced prostate cancer.

The study exposed that in developed countries, men of African descent are understated in the sampling pools in both laboratory and clinical research, and thus the applicability and significance of these results to men of African descent are cautious. Though, developing countries with high populations of black males have limited laboratory and clinical research publications. This is due to limited funding to support research programmes and basic clinical services for early detection and treatment.

The study concludes that for the involvement of developing countries in bench research, they should do it in collaboration, like fostering partnerships with credible academic-based institutions and organizations. This requires a realm of transparency, respect, protection of the rights and dignity of the patients, and equity in participation and sharing of the benefits to be accumulated. The current transatlantic and Caribbean collaborations in research, education, and health service delivery in prostate cancer care for men of African descent demonstrate the successes of such partnerships.

Research translation from the bench to bedside is one in which developing countries' focus must be collaborative. Limited resources dictate that the study authors research initiatives be directed to providing the vital clinical resources. This collaboration must be done within a realm of transparency, respect, and protection for the rights and dignity of the patients, and with equity in participation and sharing in of the benefits to be accumulated from the collaboration.

Their coalitions to date have recognized these principles through the following consortia and organizations: Men of African Descent and Carcinoma of the Prostate Consortium, the Prostate Cancer Transatlantic Consortium, the Florida Cancer Disparity Group, the African Caribbean Cancer Consortium, and the African Organization for Research & Training in Cancer. Their institutional partners, including the University of Florida, the National Institutes of Health, and the University of the West Indies, have been most supportive and generous with their collaborative assistance.

It is through these partnerships, the realities of bench-to-bedside can be realized and brought to fruition for the benefits of our respective populations and thus, health-care disparities in prostate cancer care can be reduced for the betterment of all. Indeed, the whole is greater than the sum of the individual parts. Men of West Africa descent must be proactive about their own health.

Dr. Raphael NyarkoteyObu:ND(TAP 00396)
Integrative Oncologist
MSc Prostate Cancer
Sheffield Hallam University, UK
Director of Men's Health Foundation Ghana
Ref
Robin Roberts(2014)From bench to bedside: the realities of reducing global prostate cancer disparity in black men. Ecancermedicalscience.2014; 8: 458.Published online Aug 28, 2014.doi: 10.3332/ecancer.2014.458PMCID: PMC4154941

Odedina FT, Akinremi TO, Chinegwundoh F, Roberts R, Yu D, Reams RR, Freedman ML, Rivers B, Green BL, Kumar N(2009).Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa.Infect Agent Cancer. 2009 Feb 10;4Suppl 1:S2. doi: 10.1186/1750-9378-4-S1-S2.

J Cult Divers, Kleier JA (2003).Prostate cancer in black men of African-Caribbean descent.Summer;10(2):56-61

Pedersen VH, Armes J, Ream E(2012)Perceptions of prostate cancer in Black African and Black Caribbean men: a systematic review of the literature.Psychooncology. 2012 May;21(5):457-68. doi: 10.1002/pon.2043. Epub 2011 Sep 9.

Abeyna LC Jones and Frank Chinegwundoh(2014)Update on prostate cancer in black men within the UK.Ecancermedicalscience.2014; 8: 455.Published online Aug 28, 2014.doi: 10.3332/ecancer.2014.455 PMCID: PMC4154945

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