My father was diagnosed with prostate cancer in 2002. I still remember going with him to his doctor's appointment where we nervously sat in the exam room and waited for his urologist to see us. As his doctor walked in, he shook our hands, and proceeded to tell us the results of the tests. My father had prostate cancer. I was devastated and overwhelmed with emotions, but I tried to be strong.
My father looked at me with a confused expression on his face. He wanted me to reiterate and confirm the diagnosis because he couldn't believe it. I stared back at him and as I grabbed his hand, I repeated the doctor's words, but said it in Korean. His eyes grew large and filled with fear and for a momen; I swear I felt his heart dropping within his chest, or at least I felt the heaviness of my heart as it sunk to the bottom of my stomach.
I couldn't imagine what it was like for my father to hear from his youngest daughter that he had prostate cancer. I think he may have been embarrassed, but more than that, he must have been fearful of what the future held for him. As an immigrant from Korea, his perspective of cancer was different than mine as I was born and raised in the United States. I think both my parents saw cancer as an inescapable death sentence.
Driven by a strong sense of urgency, we both asked a ton of questions and wanted to know our treatments options. He said we could either watchfully wait to see if my father's PSA level increases or we could choose from several treatment options, such as radiation therapy. My father responded by saying he would have to consult my mother and sister and as a family, we would decide on the best treatment option.
After discussing it as a family, we decided to go ahead with radiation therapy. Both of my parents wanted to eradicate the cancer and get rid of it as soon as possible and my sister and I supported the decision. In the coming weeks, I went with my father to his radiation appointments and we did everything we could to walk through this ordeal together as a family. Now, five years later, my father is cancer free.
Sometimes I wonder what makes one person more likely to develop or survive a certain disease than another person. Could ethnicity predict or even help someone overcome a certain illness or disease? How about gender or socioeconomic status? Are there factors that can predict one's ability to survive a given disease?
Was there something about my father that made him more likely to survive prostate cancer? Could it have been his diet or exercise level or maybe it was his perspective of cancer and fear of death and his love for his family that made him choose a more aggressive form of treatment.
A recent study examined whether certain characteristics explain the differences in prostate cancer survival rates among different ethnic groups. The authors of the study conclude that factors, such as age, stage of cancer, treatment, year of diagnosis, and socioeconomic status, do not explain why most Asian men have better survival compared to their white counterparts.
In addition to having the lowest mortality rate, the article claims that Asian-American men as a single ethnic group have the lowest incidence of prostate cancer. However, the authors state when Asian men are diagnosed, they have worse prognostic profiles than other men, although their survival rate is better.
Asian men may have the lowest mortality rate because they may believe that their chances of survival are best if an aggressive treatment is taken immediately upon diagnosis, rather than waiting or choosing a less intensive form of treatment. Also, Asian men may have the lowest incidence because fewer Asian men are getting screened for prostate cancer than non-Asians. I believe both of these were true for my father. He may have survived his bout with cancer because of his choice of treatment and he most likely would not have undergone a prostate cancer screening if it were not for his HMO recommending the procedure.
So, if traditional prognostic factors (age, stage, treatment, year of diagnosis, and socioeconomic status) do not explain better survival rates among Asian men, what does?
One possible reason could be that the Asian men in the study are the most likely to have health insurance, which means they are more likely to get screened and have access to various forms of treatment compared to those without insurance. If the sample was taken from a cancer registry, it may not include men who are uninsured, which means it may not be truly representative of the general public. Also, many Asians are uninsured, especially first generation immigrants, which are likely to be the men in the study given the older age of the participants. This could directly affect survival rates in Asian men since they may not be receiving proper screening and preventative services.
Secondly, in addition to lack of health insurance, many immigrants from Asia hold a different perspective and philosophy about medicine. Where Western medicine is more prevention-focused, Eastern medicine tends to focus on treatment of disease. Western medicine encourages the individual to take a more proactive approach in managing one's health, and in Eastern medicine, the individual is more reactive to an illness or disease and the emphasis is on the treatment. Therefore, an Asian man diagnosed with prostate cancer who holds an Eastern approach to medicine could be more likely to desire an aggressive treatment.
I cannot deny that factors such as access to health insurance, personal philosophy of medicine, diet and exercise play a role in prostate cancer survivorship. However, I think it is incredibly difficult to make generalizations, especially about health, that can accurately explain incidence and outcome of certain diseases. Medical research is very challenging because it attempts to inform the public at large, but by studying a pool of participants that are extremely complex; each person's background and beliefs significantly contribute to what makes each individual unique. Nonetheless, medical research is very important and participation from all ethnic groups and genders are needed in order to improve the generalizability of research findings to individuals like you and me.
Published On: August 24, 2007