Exploring the critical role of trust and healthcare access in racial disparities affecting prostate cancer screening and outcomes
Prostate cancer represents one of the most striking health disparities in modern medicine. While prostate cancer affects men of all backgrounds, African American men bear a disproportionate burden—they are 75% more likely to be diagnosed with prostate cancer and experience 2.4 times higher mortality rates compared to their White counterparts 5 . This alarming disparity has persisted for decades despite advances in detection and treatment, prompting scientists to look beyond biological factors to understand what drives these inequities.
Higher diagnosis rate for African American men
Higher mortality rate for African American men
Years these disparities have persisted
Recent research has revealed that the solution to this disparity may lie not in the laboratory, but in the human dynamics of healthcare—patient trust, consistent care, and systemic biases that unconsciously affect how healthcare is delivered and received. The complex interplay between these factors creates barriers to early detection that disproportionately affect minority populations, ultimately costing lives through later-stage diagnoses and reduced treatment success 1 4 .
Trust in healthcare providers and access to consistent care may be more significant factors in prostate cancer screening disparities than biological differences.
Medical mistrust among African American patients didn't emerge in a vacuum—it's rooted in a historical context of discriminatory practices including the infamous Tuskegee syphilis study and ongoing experiences of differential treatment within the healthcare system .
Having a regular source of care and seeing the same provider consistently represents another critical factor in healthcare utilization. Continuity of care establishes a foundation for patient-provider relationships to develop 1 .
To better understand how these factors influence prostate cancer disparities, researchers conducted a groundbreaking population-based study known as the North Carolina-Louisiana Prostate Cancer Project (PCaP). This comprehensive research effort examined the interplay between trust, care continuity, and screening utilization among newly diagnosed prostate cancer patients 1 5 .
The PCaP study's most compelling finding was the central role of care continuity in promoting screening utilization. The data showed that men who reported seeing the same physician for regular care were significantly more likely to have undergone prostate cancer screening, regardless of race 1 .
| Factor | Caucasian Americans | African Americans | P-value |
|---|---|---|---|
| Trust Score (0-100) | 62.73 | 58.48 | <0.001 |
| Usual Source of Care: Physician Office | 88.4% | 77.5% | <0.001 |
| See Same Provider consistently | 89.4% | 78.5% | <0.001 |
| Any Prior PSA Screening | 81.2% | 54.7% | <0.001 |
| Any Prior DRE Screening | 89.2% | 77.9% | <0.001 |
| Any Prior Prostate Cancer Screening | 93.9% | 81.4% | <0.001 |
Source: North Carolina-Louisiana Prostate Cancer Project 1 5
| Care Pattern | Screening Rate | Adjusted Odds Ratio |
|---|---|---|
| See same provider consistently | 89.7% | 2.41* |
| See different providers | 74.3% | Reference |
| Usual source: Physician office | 88.2% | 1.86* |
| Usual source: Other facilities | 78.5% | Reference |
*Statistically significant (p<0.05)
Understanding healthcare disparities requires sophisticated research approaches that can capture both objective metrics and subjective experiences. The following tools have been essential in advancing our understanding of trust and care continuity in prostate cancer screening:
| Research Tool | Function | Application in Disparities Research |
|---|---|---|
| Trust in Physician Scale | Validated instrument measuring interpersonal trust in patient-physician relationships | Quantifies trust levels across racial groups and correlates with screening behaviors |
| Medical Mistrust Index | Assesses fear and suspicion of healthcare institutions | Measures historical and contemporary concerns about healthcare discrimination |
| SEER-Medicare Linked Database | Links cancer registry data with Medicare claims | Allows analysis of screening patterns, diagnosis stage, and treatment outcomes by race 4 |
| Natural Language Processing (NLP) | AI-based analysis of clinical documentation | Identifies biased language in electronic health records that may affect care quality 2 6 |
| Behavioral Risk Factor Surveillance System (BRFSS) | National population-based telephone survey | Tracks preventive service utilization, including prostate cancer screening trends 8 9 |
A startling 2025 study published in PLOS ONE revealed that racial bias can infiltrate even the clinical documentation process. After analyzing over 13 million electronic health record notes, researchers found that notes written about non-Hispanic Black patients had significantly higher odds of containing language undermining the patients' credibility compared to notes about White patients 2 6 .
Analysis of data from the Behavioral Risk Factor Surveillance System showed that while screening rates declined for both Black and White men during the early pandemic, the recovery patterns differed significantly by race 8 .
| Population | 2018 (Pre-pandemic) | 2020 (Early Pandemic) | 2022 (Recovery Period) |
|---|---|---|---|
| White Men | 45.2% | 41.2% | 52.7% |
| Black Men | 55.1% | 43.2% | 52.5% |
Shared decision-making (SDM) has emerged as a promising approach for addressing disparities in prostate cancer screening. A 2023 study found that when patients reported experiencing SDM with their healthcare providers, racial disparities in PSA screening were significantly attenuated 9 .
Developing cultural competence and cultural humility among healthcare providers represents another essential strategy for addressing disparities. Cultural humility involves healthcare providers acknowledging their own biases and privileges 7 .
The racial disparities in prostate cancer outcomes represent one of our healthcare system's most persistent failures—but the research on trust, care continuity, and screening utilization points toward potential solutions. By understanding how medical mistrust develops and how inconsistent care contributes to screening gaps, we can develop targeted interventions to address these factors.
The evidence suggests that promoting continuous patient-provider relationships, addressing implicit biases in healthcare delivery, and implementing shared decision-making processes could significantly reduce disparities in prostate cancer screening. These approaches, combined with broader policy initiatives to ensure equitable access to care, offer hope for finally closing the racial gap in prostate cancer outcomes.
As we move forward, it will be essential to maintain focus on these systemic issues while continuing to research innovative approaches to building trust and ensuring that all men—regardless of race—receive the preventive care that could save their lives from prostate cancer.