Background: Black men have the highest overall prostate cancer incidence of any ethnic group in the world, 66% higher than whites in the United States alone. Black prostate cancer death rates also are higher, with 140% more succumbing to their disease. Moreover, when compared to their white counterparts, American black men present at a later stage and with higher pathological grade disease. The mechanism of the disparity remains unknown. Some biological or genetic factor may exist. However, in the US, where blacks are disproportionately poor and more likely to receive lower-quality health care, socioeconomic factors may play a role in screening and detection differences between races. This is in contrast to Bermuda, where blacks and whites are poor, middle class, and well to do in similar numbers. Thus, the Bermuda Tumor Registry at King Edward VII Memorial Hospital offers a unique study population in which to examine the basis for race-based differences in prostate cancer incidence and mortality. Here we report staging distribution data suggesting that screening in Bermuda may be more equal between blacks and whites.
Methods: Staging data from 1991-2000 for Bermuda prostate cancer patients was obtained from the Tumor Registry at the King Edward VII Memorial Hospital. Established in 1976, data is captured according to the guidelines established by the World Health Organization (WHO) and the International Association for Cancer Registrars. Since 1986 data collection has been consistent with no changes in protocol. Prostate cancer patients were staged according to the WHO staging system: local, regional, and advanced disease. Patients with unknown staging information were reported as such.
Results: Four hundred ninety-nine (499) men in Bermuda presented with prostate cancer during the study period. Of these 341 were black and 158 white. Among blacks 244 (71.6%) presented with local disease, 14 (4.1%) with regional disease, 2 (0.6%) with advanced disease, and 81 (23.7%) of unknown stage. Among whites 115 (72.8%) presented with local disease, 6 (3.8%) with regional disease, 3 (1.9%) with advanced disease, and 34 (21.5%) unknown.
Conclusions: Blacks and whites with prostate cancer in Bermuda present at a given stage in proportionate numbers, unlike in the US, where both social class and stage distribution differ significantly. Equal stage distribution among Bermudians may reflect more egalitarian screening. Consequently, this population may prove more useful than the general US population as a focus for the study of race-based differences in the diagnosis and treatment of prostate cancer

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