Prostate Cancer Screening Behavior in Men from Seven Ethnic Groups: the Fear Factor Nathan S. Consedine, 1 Amy H. Morgenstern, 2 Elizabeth Kudadjie-Gyamfi, 1 Carol Magai, 1 and Alfred I. Neugut 3 1 Psychology Department, Long Island University; 2 Intercultural Institute on Human Development and Aging, Brooklyn, New York; and 3 Department of Epidemiology, Columbia University Medical Center, New York, New York Abstract Rates of prostate cancer screening are known to vary among the major ethnic groups. However, likely variations in screening behavior among ethnic subpopulations and the likely role of psychological characteristics remain under- studied. We examined differences in prostate cancer screen- ing among samples of 44 men from each of seven ethnic groups (N = 308; U.S.-born European Americans, U.S.-born African Americans, men from the English-speaking Carib- bean, Haitians, Dominicans, Puerto Ricans, and Eastern Europeans) and the associations among trait fear, emotion regulatory characteristics, and screening. As expected, there were differences in the frequency of both digital rectal exam (DRE) and prostate-specific antigen (PSA) tests among the groups, even when demographic factors and access were controlled. Haitian men reported fewer DRE and PSA tests than either U.S.-born European American or Dominican men, and immigrant Eastern European men reported fewer tests than U.S.-born European Americans; consistent with prior research, U.S.-born African Americans differed from U.S.-born European Americans for DRE but not PSA frequency. Second, the addition of trait fear significantly improved model fit, as did the inclusion of a quadratic, inverted U, trait fear term, even where demographics, access, and ethnicity were controlled. Trait fear did not interact with ethnicity, suggesting its effect may operate equally across groups, and adding patterns of information processing and emotion regulation to the model did not improve model fit. Overall, our data suggest that fear is among the key psycho- logical determinants of male screening behavior and would be usefully considered in models designed to increase male screening frequency. (Cancer Epidemiol Biomarkers Prev 2006;15(2):228 – 37) Prostate cancer is the second leading cause of cancer death among American men (1); there are striking ethnic differences in both its incidence and mortality (2). Compared with both European American (172.9 of 100,000) and Hispanic men (127.6 of 100,000), African American men (275.3 of 100,000) have the highest incidence of prostate cancer in the United States (3) and more than twice the mortality rate of European Americans (2). Conversely, although the incidence rates between 1995 and 1999 were f20% lower among Hispanic men, prostate cancer remains the most commonly diagnosed cancer and the second leading cause of cancer death within this group (4). Scientists know almost nothing about prostate cancer in Caribbean subpopulations. Research has, however, indicated that Jamaican men (who are often classified as ‘‘African American’’) may have an incidence rate that exceeds that of U.S.-born African Americans. One study of 2,484 men in Trinidad and Tobago, a major source of English-speaking Caribbean immigrants to the United States, suggested that the rate of prostate cancer may be as high as 10% (5), with a high number of abnormal screening findings (6). Research in Kingston, Jamaica likewise suggests that the incidence may be as high as 304 of 100,000 (7). A major part of ethnic differences in mortality may result from ethnic differences in the stage of diagnosis (8); disparities are more striking for advanced tumors (3, 9). African American men are more likely to be detected with metastatic cancer (10) and are at greater risk even after adjusting for socioeconomic status, year, and age at diagnosis (11). Hispanic men are also more likely to be diagnosed with distant-stage cancers (4). Stage of presentation is a major determinant of survival (12) with estimates suggesting that 5-year survival for local and regionally advanced prostate cancers is almost 100%, whereas that for distant disease is 34% (2). Because of the complexity of prostate cancer biology and debate over the efficacy of prostate-specific antigen (PSA) screening (13, 14), doubt remains regarding whether the poorer survival of African American men reflects their later stage at diagnosis or differences in basic disease biology (15, 16): genetic, environmental, or social factors (17). How- ever, one of the largest analyses (18) showed epidemiologic changes in the Surveillance, Epidemiology, and End Results data from 1973 to 1994 consistent with an interpretation of PSA testing as being effective. In the absence of definitive evidence to the contrary, the American Cancer Society suggests that every man over the age of 50 be offered screening with an annual digital rectal exam (DRE) and PSA test (1) as long as men are informed regarding the benefits and limitations of these methods (19). Estimates suggest that African American (57.6%) and White (58.2%) men participate in PSA testing with similar frequency, although DRE rates are lower among African Americans (20). However, fewer than half of the Hispanic male population received a PSA or DRE test in 2001 (4). Screening rate differences have been associated with later stage diagnoses (21), and it has been shown that although >70% of prostate cancers among Black and White men are detected by screening , nearly 50% of prostate cancers among Hispanic men are detected due to symptoms (22). Sociodemographic characteristics and access issues have been considered a primary explanation for late stage diagnosis and screening rate differences (23, 24). Screening has been associated with race/ethnicity, education and socioeconomic 228 Cancer Epidemiol Biomarkers Prev 2006;15(2). February 2006 Received 1/11/05; revised 9/20/05; accepted 12/16/05. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Requests for reprints: Nathan S. Consedine, Psychology Department, Long Island University, 1 University Plaza, Brooklyn, NY 11201. Phone: 718-780-4368; Fax: 718-488-1433. E-mail: nconsedi@liu.edu Copyright D 2006 American Association for Cancer Research. doi:10.1158/1055-9965.EPI-05-0019