Race, prostate cancer survival, and membership in a large health maintenance organization.

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Abstract
Prostate cancer is the most common noncutaneous cancer in men in the United States. During 1998, it is estimated that 184 500 new cases will be diagnosed ( 1 ). The age-adjusted incidence rate of prostate cancer in U.S. black men is more than 30% higher than in white men, and the age-adjusted mortality rate in blacks is more than twice as high ( 2 ). Moreover, the most recent data ( 3 – 5 ) from the national Surveillance, Epidemiology, and End Results (SEER) 1 Program show that after diagnosis with prostate cancer, black men have substantially shorter survival than white men, even when diagnosed at the same cancer stage. Such stage-specific comparisons indicate that the poorer survival of black men with prostate cancer is not simply a result of diagnosis at later stages. These data have led some to hypothesize that the survival disadvantage in blacks is due to biologic factors rather than racial differences in access to health care. This hypothesis (hereafter called the biologic hypothesis) predicts that black men with prostate cancer present with a less favorable distribution of tumor stage and grade than do white men, regardless of whether the comparisons are made among men in the general population or in populations with equal access to health care.