Low Literacy, Not Race, Is Primary Barrier To Early Prostate Cancer Diagnosis Among The Poor

CHICAGO--Low literacy may be a significant obstacle in diagnosing curable prostate cancer among both low-income white and black men, a Northwestern University Medical School study has found.

While prostate cancer screening with the PSA blood test is widely available, low-literate men may not be aware of the test.

In the study, literacy levels of 212 low-income, elderly men were assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM), an individually administered reading test. Results showed that the white and black men diagnosed with advanced, incurable prostate cancer at their initial examination were twice as likely to be unable to read above the sixth grade level.

While all of the patients in the study had free access to PSA tests and general medical care, low literacy was a major problem for many in navigating the health care system.

Almost 53 percent of black men vs. 9 percent of white men had reading levels below the sixth grade.

And although black men also were more than twice as likely to have incurable cancers at initial examination, a statistical analysis that allowed for differences in geographical area and age found that low literacy, not race, was the most important predictor of having incurable prostate cancer.

Still, according to Northwestern researcher Charles L. Bennett, M.D., the higher prevalence of poor reading skills among low-income black men with prostate cancer may be an important factor in explaining why so many poor black men have incurable prostate cancers.

Other studies have found poor literacy to be an important factor in explaining low usage of preventive health services, as well as an individual's understanding of his/her medical condition, he said.

It is estimated that almost half of the adult U.S. population has insufficient literacy skills, and that 23 million adults are functionally illiterate.

"Among low-income black and white men, the elderly are particularly hindered by literacy barriers," Bennett said.

Having incurable cancer at initial diagnosis also may be due to low-income black men not being aware of such newspaper-advertised events as Prostate Cancer Awareness Week and prostate cancer screening programs at churches, schools, clinics, county hospitals and Veterans Administration medical centers.

Culturally sensitive, low-literacy educational materials developed in collaboration with target populations may improve patient awareness of prostate cancer, Bennett said.

Bennett is an assistant professor of medicine at the Medical School, a staff physician at Northwestern Memorial Hospital and the Chicago Veterans Administration Healthcare System/Lakeside Division and director of the Cancer Policy and Outcomes Research Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. He is a recipient of a Career Development Research Award from the Department of Veterans Affairs.

Co-authoring this study were Northwestern researchers Jaeson Kaplan, M. Rosario Ferreira, M.D., and Timothy M. Kuzel, M.D., associate professor of medicine, Oliver Sartor, M.D., chairperson of the Louisiana State University Cancer Center, Shreveport, La., and Terry Davis and Maribeth Weinberger, also of Louisiana State University.

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