Caribbean

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Comment by Kathy Meade on July 1, 2008 at 1:35am

Dr. Michael O'Leary, a professor of surgery at Harvard and a senior Urologic surgeon at Brigham and Women's Hospital, and the Bermuda Cancer and Health Centre are urging men on the Island to visit their primary doctors.
http://tinyurl.com/3gjo5p

Comment by Nathan Consedine on June 10, 2008 at 9:19am

Mike, et al.,

I'm relatively new here and at risk of being viewed as (excessively) self-promoting thought I would mention that there is a growing body of data describing the screening patterns, attitudes and knowledge among Caribbean men living in Brooklyn, New York. I've pasted a few of the references describing some of this work below and am happy to provide the papers if people are interested.

Consedine, N. S., Adjei, B. A., Ramirez, P. M., & McKiernan, J. M. (in press). An object lesson: Differences in source determine the relations that trait anxiety, prostate cancer worry, and fear of screening hold with prostate screening frequency. Cancer Epidemiology, Biomarkers, & Prevention.
Consedine, N. S., Christie, M. A., & Neugut, A. I. (in press). Factors associated with initial and repeat PSA screening in Caribbean, African American, and White men in Brooklyn. British Journal of Health Psychology.
Kudadjie-Gyamfi, E., Consedine, N. S., Ungar, T., & Magai, C. (2008). Predicting digital rectal exam frequency with coping styles. American Journal of Health Behavior, 32 (2), 188 – 200.
Consedine, N. S., Horton, D. Ungar, T., Ramirez, P., Joe, A., Borrell, L. (2007). Fear, knowledge and efficacy beliefs differentially predict the frequency of DRE and PSA screening in samples of older men. American Journal of Men’s Health, 1 (1), 29 – 43.
Phillips, A. A., Jacobson, J. S., Magai, C., Consedine, N. S., Horowitz-Mehler, N. C., & Neugut, A. I. (2007). Cancer incidence and mortality in the Caribbean. Cancer Investigation, 25 (6), 476-483.
Consedine, N. S., Morgenstern, A. H., Kudadjie-Gyamfi, E., Magai, C., & Neugut, A. I. (2006). Prostate cancer screening behavior in men from seven ethnic groups: The fear factor. Cancer Epidemiology, Biomarkers, & Prevention, 15 (2), 228 – 237.
Kudadjie-Gyamfi, E., Consedine, N. S., & Magai, C. (2006). On the importance of being ethnic: Coping with the threat of prostate cancer in relation to prostate cancer screening. Cultural Diversity & Ethnic Minority Psychology, 12(3), 509-526.

Comment by Dr Brent Wilson on June 8, 2008 at 8:12am

Gerrtings from Trinidad. Mike wrote, "Another thought. Does anyone have a clue what percentage of Caribbean males ever get a prostate specific antigen test (let alone a DRE)? I'll bet a plugged nickel that the lifetime incidence is less than 10 percent for the PSA and significantly lower for the DRE." This is purely anecdotal but, before I was required to have a medical for my current occupation, I had not even heard of either.

Comment by E. Michael D. ("Mike") Scott on April 13, 2008 at 11:27pm

Given the apparent paucity of information about PCa in the Caribbean, I'd like to build a simple page on The "New" Prostate Cancer InfoLink main site that could act as a basic guide for anyone looking for core information.

We have the incidence/prevalence data found by Dr. Krongrad, but what might be helpful for everyone would be a relatively simple "resources" guide to whatever is available in the Islands, and where. Please let me know if you can help with this.

Mike

Comment by Dr. Mitchel E Penn on April 13, 2008 at 8:47am

This is a very important conversation about the Caribbean, a place I call home. While I do not have many solutions I am aware that PCa is top on the medical agenda in the North of the Caribbean.
NGO's are operating in a few Islands annually to help detect disease. But the major problem is surgical treatment and cost.

Comment by Ralph Valle on March 29, 2008 at 12:11pm

The wall will come down. It is just that it is taking so long!The very fact that men do not have a government department of men's health is telling how far behind we are on health issues.

Overcoming the myths associated with prostate cancer require forums such as this. Many organizations are working to tear the wall down, but for many reasons we (men) can't get our act together yet. Thanks for supporting forums such as this one and for your support in our battle to tear the wall.

Comment by Arnon Krongrad, MD on March 28, 2008 at 4:31pm

The wall is coming down Ralph.

Before I wrote the global epidemic story for "Behind the Mask" I ran my argument by Otis Brawley, the new CMO of the American Cancer Society. Otis has been a critical reader of the PSA data. Upon review, he asked me to send him the two references upon which I relied: the Tyrol data and the Seattle data. He had not been aware of the latter. Upon review, he admitted to me that the data -- especially the Seattle data, in his view -- argued that screening may be effective "in some populations." Later, when I sent the piece to Georg Bartsch, I learned that he too was not aware of the Seattle data.

Communication is a key to progress. Communication has broken down here and there. Our efforts, from the "Behind the Mask" series to this new social network, to the international effort in the Caribbean, to the "New" Prostate Cancer InfoLink are key to communication.

Thank you for joining in. It's nice to know you. And please bring your friends. I get the sense you know a lot of people.

Comment by Ralph Valle on March 28, 2008 at 12:22pm

I read with interest the comment made by the British physician saying that the reason for the under use of PSA testing in Cuba is due to the American blockade. Cuba buys from Canada and many European countries. I am sure those could provide Cuba with the proper equipment if there would be any public health interest in doing so.

The divided medical opinion about the value of PSA is an anchor around the neck of PCa activism promoting awareness. Here in this country, the USPSTF recommends against PSA testing and many family practitioners (gate keepers)follow their guideline. In spite of this and with the current use of PSA testing here there has been a 33% of reduction in PCa deaths. The notion that PSA is widely used here is not true. Not true when there is such strong opposition by those that dictate policy and by current stats. The Tyrol experiment on the other hand, is the best example that early detection and treatment intervention result in reduced disease-specific deaths. This evidence continues to be ignored.

Comment by Ralph Valle on March 26, 2008 at 10:08am

This data seems to be the same as available at WHO. For years PCa mortality in the Caribbean has been exceedingly high. No question that most cases are diagnosed late and PSA testing and DRE are less used than in other regions. I know that the impact of diet on PCa is controversial, but this region in particular eats industrial amounts of saturated animal fat.

Comment by E. Michael D. ("Mike") Scott on March 26, 2008 at 9:02am

Arnon: Here's something interesting that you might want to read on the plane to Provo.

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