D isagreement abounds in the study of racial differences in prostate carcinoma. For instance, can we agree on the definition of a racial group? Are black Americans at greater risk for prostate carcinoma than non-Hispanic whites? Do black Americans have more aggressive cancer than whites? Are recurrence and survival rates similar after treatment? What is the impact of confounding variables, detection bias, and ascertainment bias in measuring differences among racial groups? What about access to care and choice of treatment? Differences in prostate carcinoma risk among any population groups, whether stratified by race, country of origin, or another variable, may reflect exposure differences, differences in detection, and biologic differences. Dissecting the influence of each factor separately is a daunting and perhaps impossible task.
First, can race be defined? Anthropologists contend that race is a sociopolitical category of populations rather than a biologic category. Consequently, they claim that race cannot be separated from culture and socioeconomic status, and these have substantial effects on health and illness. Despite such claims, population-based studies that rely on race are often employed by social scientists, anthropologists, and, ultimately, physicians, to stratify populations and patients. There are plentiful examples of diseases for which the risk differs according to race; they include sickle cell anemia, lupus erythematosus, and even heart disease. Why deny the possibility that certain inherent racial differences predispose to prostate carcinoma risk or poor prognosis, even if our definition of race is imperfect? More importantly, if we can successfully stratify patients for any risk variable, regardless of the variable employed (such as a sociopolitical category), then our understanding of an illness is advanced and we can develop effective strategies for managing subsets of patients. Thus, despite concerns about the biologic reality of race, it seems practical and appropriate to study population differences.
However, race is a continuous variable of genetic diversity, perhaps best exemplified by the melting pot of American society. If a genetic scale could unambiguously separate races, then we could determine the significance of race in the development of a polygenic disease, such as prostate carcinoma. Lacking such a measure, we continue to search for differences, but much of our effort is stymied by artifacts of detection and screening.
Second, are blacks at greater risk for prostate carcinoma than whites? Black American men have the highest incidence rate of prostate carcinoma in the world. For the period 1988 -1992, race specific