1. A Clinical Profile of Male Health in the Bahamas “Real Men Die from Prostate Cancer” A Clinical Profile of Male Health in the Bahamas “Real Men Die from Prostate Cancer” Dr. Robin Roberts MD MBA Urologist, Associate Lecturer University of the West Indies, Bahamas Campus

3. Copyright ©2003 American Cancer Society From Jemal, A. et al. CA Cancer J Clin 2003;53:5-26. FIGURE 3 Annual Age-adjusted Cancer Incidence Rates* Among Males and Females for Selected Cancer Types, US, 1973 to 1999

4. Pienta, K. J. et. al. Ann Intern Med 1993;118:793-803 Prostate cancer incidence rates for the years 1973 to 1990

5. Prostate Cancer Death Rates* by Race/Ethnicity, United States, 1992–2001 ( CDC National Center for Health Statistics)

8. Developed Countries vs. Developing Countries HEALTH CARE DISPARITY HEALTH CARE DISPARITYvs. HEALTH CARE PARADOX HEALTH CARE PARADOX

10. Vol. 159, 1984-1987, June 1998 Printed in U.S.A THE EPIDEMIOLOGY OF PROSTATE CANCER IN JAMAICA FRANK E. GLOVER, JR., DONALD S. COFFEY, L. LAWSON DOUGLAS, MARK CADOGAN, HOPE RUSSELL, TREVOR TULLOCH, TIMOTHY D. BAKER, ROBERT L. WAN AND PATRICK C. WALSH From the School of Hygiene and Public Health, The Johns Hopkins University and The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, and the University of the West Indies, Mona, Kingston, Jamaica United States 1992 White men 182/100,000 Black men 249/100,000 Jamaica men: 304/100,000

11. High Prevalence of Screening-detected Prostate Cancer among Afro-Caribbeans: The Tobago Prostate Cancer Survey: Cancer Epidemiology, Biomarkers & Prevention Vol. 11, 726–729, August 2002 2484 men ages 40 to 70 yrs ( 50% of all the men in Tobago) Sept 1997 to June 2001 Screening detected Prevalence Rate: 3 to4X higher than the US Caucasian population

12. Prostate Cancer Incidence & Mortality Clinical Profile Early Detection Campaign

13. METHODOLOGY Patient Data: Patient Data: Records PMH, Doctors Hospital, MD office Records PMH, Doctors Hospital, MD office Logs: OR, Pathology Logs: OR, Pathology Health Information & Research Unit MOH: Health Information & Research Unit MOH: Country health profile studies Country health profile studies Morbidity & Mortality data Morbidity & Mortality data Cancer Society: US TOO Cancer Society: US TOO Prostate Cancer Awareness Week Prostate Cancer Awareness Week Patient Questionnaire Patient Questionnaire

15. Trends in Selected Leading Causes of Death All Ages, Both Sexes( rates per 100,000 Population), Bahamas, 1993-2003

16. Trends in selected Leading Causes of death for Males (rates per 100,000 Population, Bahamas 1993 - 2003

17. Trends in Selected Leading Causes of death For the Elderly 65 years and older (rates per 100,000 Population, Bahamas 1993 - 2003 160

18. Bahamas Cancer Mortality Trends Death rates per 100,000

19. Rates (100,000 Persons) of Deaths Due to Prostate cancer and Total Cancers for Males by Age

21. Prostate Cancer: Bahamas Total New cases 2005 – 60: AA: 40,000 (40-70yrs) Total New cases 2005 – 60: AA: 40,000 (40-70yrs) 1991 to 1995: 32AA: 80/100,000 1991 to 1995: 32AA: 80/100,000 1996 to 2000: 49.2AA: 123/100,000 1996 to 2000: 49.2AA: 123/100,000 2001 to 2005: 53.6AA: 134/100,000 2001 to 2005: 53.6AA: 134/100,000 Age 2005: Ave 67yrs Age 2005: Ave 67yrs 1990: 75yrs 1990: 75yrs 2000: 65yrs 2000: 65yrs Family Islands : 31.6% Family Islands : 31.6% (2/60 non-Bahamians) (2/60 non-Bahamians)

22. Prostate Cancer: Bahamas Risk Profile: PSA, Gleason Score, Stage Risk Profile: PSA, Gleason Score, Stage 1990: <10% Low risk 1990: <10% Low risk 2000: <10% Low Risk 2000: <10% Low Risk 2005: 16% Low risk 2005: 16% Low risk 2005: 70% High risk 2005: 70% High risk

23. Young Men And Prostate Cancer 2005 Series: 2005 Series: 8/60 (13%) <60 years 8/60 (13%) <60 years 3/8 were low Risk, 4 Advanced 3/8 were low Risk, 4 Advanced 1987 to 2004 1987 to 2004 8 men were <50 years of age 8 men were <50 years of age 4/8 were advanced Disease 4/8 were advanced Disease African Decent: Start screening at 40 years African Decent: Start screening at 40 years

24. Bahamas Prostate Cancer 2000

26. Cancer Society: US TOO Prostate Screening Clinic Attendance

27. Questionnaires Questionnaires Means of Influence 2005 Means of Influence 2005 Radio Advertisements32% Radio Advertisements32% Spouse or male Friend: 31% Spouse or male Friend: 31% Return Annual Checkups Return Annual Checkups Visited Last year40% Visited Last year40% At least once in 5 Years30% At least once in 5 Years30%

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29. Male Health: Stark Realities!! Developed World: Developed World: 1990 to 2000: Incidence PCA Increased 1990 to 2000: Incidence PCA Increased Mortality Decreased Mortality Decreased Bahamas: Bahamas: 1990 to 2000: Incidence PCA Increasing 1990 to 2000: Incidence PCA Increasing Mortality Increased Mortality Increased

30. Prostate Cancer Charity UK 1996

31. Our Male Culture: Caribbean/Bahamian/African American Sunday Christian Man Sunday Christian Man Responsible Responsible Provider Provider Leader Leader Protector Protector Family man Family man The “Real Man” Don’t Visit doctors Don’t get sick Risk seeking behavior Don’t fell & Express Emotions Renowned for his female Exploits

32. The Digital Rectal Examination???? Homophobia: Homophobia:

33. THE REAL CHALLENGE Education & Awareness Change of Behavior X

34. Prostate Cancer in the Bahamas/Caribbean A Major Public Health issue A Major Public Health issue Minimal Impact of PSA Screening Programs Minimal Impact of PSA Screening Programs Ideal Treatment? Volumes vs. Expertise? Ideal Treatment? Volumes vs. Expertise? Advanced disease and high mortality Advanced disease and high mortality Outcome of the “Real Man” Cultural Ethos Outcome of the “Real Man” Cultural Ethos Need for a more aggressive and innovative male health initiatives…..Ripe old age! Need for a more aggressive and innovative male health initiatives…..Ripe old age!