younger ages in African-American men and recommendations are that they begin screening earlier than white men.

Men who are American Indians and Alaskan Natives are much more likely than white men to have their prostate cancer detected at a more advanced stage (12 versus 5 percent) (Figure 2-25). African-American men are somewhat more likely than white men to have advanced disease at diagnosis (7 versus 5 percent).

In one recent study, comorbidity at the time of diagnosis explained some of the increased mortality among African Americans. However, men without any comorbid conditions at the time of diagnosis had higher mortality (Freeman et al., 2004). Investigators speculate that these men may have had more limited contact with the health care system and therefore failed to have their cancer detected at an early stage. Other research has indicated that men with less than a high school education have much lower survival rates from prostate cancer, even after controlling for stage and

FIGURE 2-25 Stage at prostate cancer diagnosis, by race and ethnicity, U.S., SEER 1996 to 2000.

SOURCE: Ward et al. (2004).

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