April 22, 2024 – MeIn Miami's Little Haiti neighborhood, four RVs regularly appear in parking lots of places like churches and libraries. These mobile testing units, also known as „man buns,“ provide prostate cancer testing and education as a way to reach patients who lack reliable access to care.
The initiative, which encourages men to receive cancer screening and education recommendations, began in Miami in 2018 and was sponsored by the University of Miami Sylvester Comprehensive Cancer Center. Testing for prostate cancer was added about six months ago, and about 400 men have been tested so far. A similar program will launch in New York City through the Mount Sinai Tisch Cancer Center in 2022, and countries from the United Kingdom to Brazil to Uganda are also experimenting with ways to provide testing to their citizens.
In Miami, the van turned out to be an ideal approach for conducting tests that could, in some cases, do more harm than good. That's because the question of whether men should be tested for prostate cancer is complex. And men at high risk for dangerous types of prostate cancer are the least likely to be tested. A van and local health workers in it are trying to find them.
Who should get tested?
Efforts to increase screening tests are important because a leading medical journal predicts that there will be millions more cases of prostate cancer worldwide this month. In what appears to be an undervalued recommendation, the authors argue that these mobile testing units, also known as „man buns,“ will help slow the estimated increase in prostate cancer cases, which are projected to double by 2040. suggested that it might be helpful.
new report in a diary lancet Black men should be eligible for a simple blood test called a PSA test starting at age 45, the authors say, while other populations may be eligible between ages 50 and 69. Although testing needs to be done in tandem with education and outreach programs, they also say this type of mobile screening is a possible tool for a growing number of communities with limited access to health care. Ta.
Report co-author Brandon Mahal, M.D., Ph.D., an associate professor at the University of Miami, said black men are twice as likely to develop prostate cancer as the general population. He said some men at high risk for prostate cancer include:
- identify as black, especially black people of West African descent
- Comes from a family with a history of prostate cancer
- Be from a family with a history of breast or ovarian cancer
- have a genetic risk factor called BRCA mutations
A simple blood test is the first step in detecting the disease in its earliest stages, when it is most treatable. This analysis, called the PSA test, looks for a protein called prostate-specific antigen, which is produced by both cancerous and noncancerous tissue in the prostate. The prostate is a gland that plays a role in male hormonal, reproductive, and urinary functions.
The problem is that the PSA test alone doesn't necessarily distinguish between the types of prostate cancer that are very dangerous and the types that men can probably live with for the rest of their lives and have no problems at all. And once people hear the word „cancer,“ they often end up pursuing treatments that some experts say are unnecessary and come with risks such as impotence and infertility. .
a paper A paper published last year in a prestigious British medical journal said that PSA testing „remains very important, as it is unclear whether the benefits of reduced prostate cancer mortality offset the harms of overdiagnosis and overtreatment.“ „is controversial,“ he concludes.
Dr. Andrew Vickers, lead author of the UK paper and a biostatistician at Memorial Sloan Kettering Cancer Center, said: „Unless you hear you have cancer and are comfortable not treating it, don't use a PSA test or biopsy.'' Please don't accept it.“ in New York City.
That's because many doctors recommend active surveillance, observation, or Because it recommends an approach such as watchful waiting.
The current recommendation for PSA testing in the United States is for men ages 55 to 69 to talk to their doctor about the benefits and risks of getting a PSA test. However, Mahal and his co-authors of his new recommendations lancet They argue that there is value in strongly recommending screening for high-risk groups such as black men.
„These men are the least likely to have a PSA test, most likely because they have less access to health care, less access to primary care services that offer the test, or a PSA test.“ „The risk is higher in that population,'' Mahal said.
He said the current recommendations in the United States are „not a very strong statement“ and noted that the series of changes to recommendations in recent years may be difficult for primary care providers to keep up with.of Website That's because the task force making the recommendations says more changes are being considered, possibly including changes based on age, race, ethnicity and family history.
„Cancer screening recommendations are centered around the benefit of the group, not the individual,“ explains Erin Kobetz, Ph.D., MPH, professor of medicine and public health sciences at the University of Miami. “This is a strategy for public health management, and in some cases these recommendations may change because, certainly, specific testing for high-risk individuals or specific groups of high-risk individuals may be necessary. There may be benefits to doing so, but you would be endorsing it for all individuals within a certain range.'' Different age groups may result in the solution Problems may occur. PSA is one of them. ”
Current numbers suggest that 1 in 8 men Prostate cancer will occur in the United States, which is the second leading cause of cancer death in men after lung cancer.
Potential changes being considered by the influential U.S. Preventive Services Task Force could mean the task force is seeking to strike a more sophisticated balance between the harms and potentially life-saving benefits of PSA testing. It shows that there is a gender.
Compatibility of Precision Medicine and PSA Screening
Cancer testing at one of our mobile units in Miami typically requires only an in-person visit. This vehicle is designed to attract attention and is brightly decorated by a renowned Miami artist. The artwork itself can be a conversation starter.
The mobile cancer education and screening vehicle operated by the University of Miami Sylvester Comprehensive Cancer Center is called the „Game Changer Vehicle“ (GCV). The community health worker team speaks English, Haitian Creole, and Spanish. Team members typically come from the same community they serve, and all are natural helpers.
“They know how to have conversations about sensitive topics like cancer, while being sensitive to social culture (customs), and we educate them to talk about the risks and benefits of screening.” Associate Director Kobetz said. At the University of Miami Sylvester Comprehensive Cancer Center.
The mobile team uses a common electronic medical records system called EPIC, except that its version is custom-designed for the non-traditional medical environment inside the RV. Electronic health records allow patients to access their information through a mobile phone app and give them a way to send messages to their healthcare team. A version specifically designed for Game Changer Vehicles streamlines the process of setting someone up in a system of record, which is notoriously time-consuming in the medical field.
“One thing we know is that commitments can be an unnecessary barrier, so we enroll people on the spot,” Kobets said.
Healthcare workers spend most of the week in their RVs out in the community, but they also spend an extra day or two a week calling patients to give them test results or, if they can't be reached, sending certified mail. or visiting the patient's address. Discuss the results with each family. Sometimes I go with patients for follow-up visits.
Men who have been tested for prostate cancer will also be invited to participate in Mahal's research project, which examines the role of genetics, environment, and individual lifestyle factors such as diet and exercise.
„One of the benefits of looking at a complex disease like prostate cancer in a diverse city like Miami is that there are a variety of exposures, which helps us understand the factors that drive risk for this complex disease. „It helps us do that,“ he said.
Around the world, the medical field is working towards so-called precision medicine, such as creating treatments and personalized vaccines that are tailored to the specific characteristics of a person's disease. The Game Changer Vehicle combines precision medicine and community health. It's a one person at a time approach.
„There's always going to be cynics and detractors,“ Kobets said. “We're approaching this from a perspective of not just providing screening, but educating and hopefully changing the social and structural barriers to cancer prevention more broadly.”
Kobetz said that while she is not sure whether their research can change overall cancer rates, „we believe that by engaging and being a part of the community, we can improve our health and I think we've seen over time that health-related research, and ultimately the way we look at health, has changed.''That's critical to changing the direction of healthy stocks. ”