title: Perceived family history risk and symptomatic diagnosis of prostate cancer: the North Carolina Prostate Cancer Outcomes study.
abstract: BACKGROUND
  Prostate cancer (PrCA) is the most common cancer and the second leading cause of cancer death among US men. African American (AA) men remain at significantly greater risk of PrCA diagnosis and mortality than other men. Many factors contribute to the experienced disparities.
  
  
  METHODS
  Guided by the Health Belief Model, the authors surveyed a population of AA and Caucasian men newly diagnosed with PrCA to describe racial differences in perceived risk of PrCA and to examine whether 1) perceived high risk predicts greater personal responsibility for prostate care; and 2) greater personal responsibility for prostate care predicts earlier, presymptomatic diagnosis. Multivariate general linear modeling was performed.
  
  
  RESULTS
  The authors found that men with a PrCA family history appreciated their increased risk, but AA men with a family history were less likely to appreciate their increased risk. Nevertheless, neither reporting a PrCA family history nor perceived increased risk significantly predicted screening and preventive behaviors. Furthermore, higher physician trust predicted increased likelihood to have regular prostate exams and screening, indicating that the racial differences in seeking prostate care may be mediated through physician trust. Expressed personal responsibility for screening and more frequent preventive behaviors were associated with more frequent screening diagnoses, fewer symptomatic diagnoses, and less frequent advanced cancers.
  
  
  CONCLUSIONS
  Together, these results indicate that appreciating greater risk for PrCA is not sufficient to ensure that men will intend, or be able, to act. Increased trust in physicians may be a useful, central marker that efforts to reduce disparities in access to medical care are succeeding.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27709-2194, USA. pspain@rti.org
authors.forename: Pamela
authors.initials: P
authors.lastname: Spain
authors.forename: William R
authors.initials: WR
authors.lastname: Carpenter
authors.forename: James A
authors.initials: JA
authors.lastname: Talcott
authors.forename: Jack A
authors.initials: JA
authors.lastname: Clark
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Do
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hamilton
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Galanko
authors.forename: Anne
authors.initials: A
authors.lastname: Jackman
authors.forename: Paul A
authors.initials: PA
authors.lastname: Godley
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D020022:Genetic Predisposition to Disease; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010465:Perception; D010817:Physician-Patient Relations; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000208:ethnology* / Q000523:psychology*; D012306:Risk; D012959:Socioeconomic Factors; D044465:White People
references.citation: Eur J Cancer. 2000 Jan;36(2):235-41
references.pmid: 10741283
references.citation: Br J Cancer. 2006 May 22;94(10):1361-8
references.pmid: 16641912
references.citation: Milbank Mem Fund Q. 1966 Jul;44(3):Suppl:94-127
references.pmid: 5967464
references.citation: Cancer Epidemiol Biomarkers Prev. 2006 Nov;15(11):2167-73
references.pmid: 17119042
references.citation: Am J Epidemiol. 2003 May 15;157(10):940-3
references.pmid: 12746247
references.citation: Rev Urol. 2002;4 Suppl 5:S3-S10
references.pmid: 16986064
references.citation: Med Care. 1998 May;36(5):728-39
references.pmid: 9596063
references.citation: J Ambul Care Manage. 2004 Oct-Dec;27(4):348-55
references.pmid: 15495747
references.citation: Prev Med. 2004 Jun;38(6):777-85
references.pmid: 15193898
references.citation: Cancer Epidemiol Biomarkers Prev. 2000 Dec;9(12):1323-8
references.pmid: 11142417
references.citation: Milbank Q. 2001;79(4):613-39, v
references.pmid: 11789119
references.citation: Urology. 2007 Nov;70(5):950-5
references.pmid: 18068453
references.citation: J Natl Black Nurses Assoc. 2007 Jul;18(1):21-9
references.pmid: 17679411
references.citation: J Cancer Educ. 2005 Summer;20(2):96-102
references.pmid: 16083373
references.citation: BJU Int. 2002 Nov;90(7):686-93
references.pmid: 12410748
references.citation: J Natl Cancer Inst. 2002 Jul 3;94(13):981-90
references.pmid: 12096083
references.citation: J Natl Cancer Inst. 2003 Jun 18;95(12):868-78
references.pmid: 12813170
references.citation: Psychooncology. 2004 Feb;13(2):80-5
references.pmid: 14872526
references.citation: Urology. 2002 Jun;59(6):895-900
references.pmid: 12031377
references.citation: BMJ. 1995 Nov 18;311(7016):1340-3
references.pmid: 7496284
references.citation: JAMA. 1998 Nov 18;280(19):1690-1
references.pmid: 9832001
references.citation: Am J Public Health. 2000 Oct;90(10):1595-600
references.pmid: 11029994
references.citation: Cancer. 2007 Apr 15;109(8):1599-606
references.pmid: 17354220