OJ Simpson Dead: Let's Review Racial Gap in Prostate Cancer Mortality

Even if you can't say anything nice, you can always look at mortality trends

Yeah, OJ Simpson, huh.

So I will have something else to share about what I was doing 30 years ago, later, but for right now, this is what one of my favorite “news” sources has done:

(I’ve always wanted to write “An actuary reads The Weekly World News” a la A Mathematician Reads the Newspaper)

But even if I have nothing nice to say about OJ Simpson, I can take the circumstances of his death, and do something with it. My understanding is he was diagnosed with prostate cancer last year and underwent chemo.

Racial Gap in Prostate Cancer Mortality

Every November since 2017, I’ve raised funds for the Movember Foundation, which focuses on men’s health, particularly prostate and testicular cancer.

In last year’s fundraiser, I pointed out the large racial gap in prostate cancer mortality:

I could add some more recent data, but there is really no need (and I’m having issues with CDC Wonder right now). You can see the huge mortality gap.

The long-term trend, 1968-2022, looks similar to the general population, but the rates are at higher levels:

OJ Simpson was 76 years old when he died, fitting in the 75-84-year-old grouping.

Some things I noticed in the trends were that the general trend for black men was better than the general population since 2000, but that there was a higher rate at all age groups.

I don’t know if the disparity is coming from a higher genetic propensity to prostate cancer to begin with, less screening, less health care treatment or less aggressive interventions, or a combination of all of these.

Media Coverage of Prostate Cancer in Light of OJ Simpson’s Death

I think this is a positive to come out of a notorious person’s death. We all die of something, and if somebody with a sordid past dies of something common that needs more awareness, what a great opportunity to raise that awareness.

ABC News: OJ Simpson dies after prostate cancer diagnosis: What to know about PSA screening

O.J. Simpson died at 76 following a diagnosis of prostate cancer, which is the second-leading cause of cancer deaths according to the American Cancer Association.

In May 2023, Simpson posted a video on X, then known as Twitter, revealing that he had recently "caught cancer" and "had to do the whole chemo thing." He added, "It looks like I beat it." Simpson didn't specify the nature of the cancer at the time.

In February, it was revealed Simpson was getting chemo for prostate cancer treatment.

Like many cancers, early detection is key. Prostate cancer can be screened for with a blood test called Prostate-Specific Antigen (PSA). The goal of screening is to catch cancer before symptoms present and can be done during medical check-ups.

….

But the PSA screening test isn't perfect, and right now, screening is not recommended for everyone. The United States Preventive Services Task Force (USPSTF), which helps establish standards for screening tests, says the decision to screen people aged 55-69 for prostate cancer should be a choice between the individual and their healthcare provider.

"PSA is not the perfect test to diagnose prostate cancer, but it is the simplest test we actually have available...PSA was picking up a lot of men who had prostate cancer, but it was also picking up patients who didn't have prostate cancer," said Patel.

I may write about the false positive and false negative problem later.

Some providers choose to pursue testing as early as 40 in those of high risk, which include those with "any family history of prostate cancer, specifically, if there's a first degree relative, so a father or brother, that has a history or a diagnosis of prostate cancer…or men that are of African American descent," said Dr. Seixas-Mikelus who specializes in Urologic Oncology and Robotic Surgery at The Urology Clinic in Sumter, South Carolina.

I’m not sure there is broad awareness that African-American men have higher risk factors for prostate cancer.

Notably, the USPSTF does not recommend screening over the age of 70. "As men age, prostates get larger, and in general PSAs can rise just based on age," said Patel.

….

The USPSTF is currently reviewing the guidelines for prostate cancer screening and recommendations may change in the next few years.

Yeah, because prostate cancer deaths have been rising (for black men and non-black men, too. But that may be due to the pandemic disrupting healthcare.)

Prostate Cancer: Top Cancer Cause of Death for Black Men

USA Today: O.J. Simpson died from prostate cancer: Why many men don't talk about this disease

O.J. Simpson, the football star and actor whose life took a shocking turn when he was accused of stabbing to death his ex-wife and a man who was with her the night of the killings, died of prostate cancer at the age of 76.

The news has come as a surprise to many, as Simpson kept his prostate cancer diagnosis out of the spotlight, even assuring his X followers his "health is good" in a video in February, his last post on the social media site before his death. According to men's health experts, it's common for men to struggle sharing their health problems publicly, in part, due to our culture's view of masculinity.

Add on top of that the complications of prostate cancer in particular − which can include the loss of sexual function − and you have an illness that's especially difficult for men to admit they have, though it is one of the most common cancers.

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Prostate cancer affects about 1 in 8 men and 1 in 6 Black men during their lifetimes. The nonprofit American Cancer Society said it's the most common form of cancer in men other than skin cancer, and the risk of getting it increases with age.

Haywood said prostate cancer is very treatable, and only about 3% of men die from it. Still, he said men's reluctance to share their health issues with each other makes treating prostate cancer more difficult. This is because family history impacts one's prostate cancer risk, and many men don't know if they have a family history of the illness, because their relatives don't want to talk about it.

Black men in the U.S. have a fairly high lifetime incidence of prostate cancer.

But doing a quick query from CDC WONDER:

This is not the easiest table to read — I pulled information on all cancer deaths of black men in the U.S. in 2022, grouped by major cancer types.

The top cancer death category was lung cancer and #2 was prostate cancer.

Prostate Cancer is Very Survivable

TODAY: What kind of cancer did O.J. Simpson have? Former NFL star dies at age 76

Prostate cancer is most treatable if detected early. It usually grows slowly and stays within the prostate gland. However, there are some types that are aggressive and spread quickly.

“If it’s caught early, prostate cancer is very treatable, very curable,” Dr. Abhinav Khanna, a urologist at the Mayo Clinic in Rochester, Minnesota, told NBC News.

The Prostate Cancer Foundation recommends that Black men or men with a family history of cancer get screened starting at age 40. Otherwise, the recommended age to start screening is 45.Black men may have a greater risk of prostate cancer than other races and are more likely to develop aggressive or advance prostate cancer. Black men in the U.S. are also twice as likely to die of prostate cancer as white men, NBC News reported. It's not clear why, but one possible explanation is that Black men are less likely to be screened or receive treatment, research has shown.

“Not all prostate cancer is lethal, but we have seen that black men do have a higher risk of dying from prostate cancer,” Khanna added.

It's not known what causes prostate cancer, but there are some factors that increase one's risk. In addition to race, being over 50, having family history of breast or prostate cancer, and having obesity can all play a role.

The focus, though, should be on survivability.

This Healthline article: Prostate Cancer Survival Rates in Black Americans emphasizes the downside too much, so let me recast some of their stats:

The 5-year prostate cancer survival rate for localized cancer is 96 percent for Black men, compared to 98 percent for white men (based on data from 2011 to 2017). Metastatic prostate cancer survival rates are lower.

“Localized cancer” is when the cancer cells are still located in the prostate (as opposed to the metastatic cancer diagnosis my husband Stuart had in which the cells had spread into his bones throughout his body).

From my experience, it’s not a good idea to look at survival rates for metastatic cancer from over a decade ago, especially for prostate or breast cancer.

I made that mistake when Stu was diagnosed in 2017: the one-year survival rate was 50%. The five-year survival rate was 2%. It’s now 2024, and I’m still dealing with Stu’s bad puns.

The issue is that cancer treatment is being developed rapidly for many cancers, especially the most common ones.

But back to the point: the survivorship for prostate cancer is near 100% now, for both black and white men in the U.S.

But you have to be diagnosed early enough.

Yes, there had been a 2-percentage-point difference in the data of about a decade ago. Some of the problems in prostate cancer mortality for black men in the U.S. has been:

• Frequency of having prostate cancer (may be genetic, lifestyle factors)

• Likelihood of having an aggressive form of cancer (most likely to be genetic)

• Stage of cancer when first diagnosed (related to screening frequency, aggressiveness of cancer)

With a higher base frequency of having cancer to begin with, and then being more likely to have more aggressive, black men may be more likely to have advanced prostate cancer when diagnosed.

It’s tough to deal with — Stu was 55 when he was diagnosed with advanced prostate cancer. The oncologist said she usually treats men 20 years older than him, and they can’t deal with the treatment because it’s so harsh. Stu could deal with it because he was in pretty good health and relatively young when diagnosed.

Takeaways

So, bottom line:

Men, if you’re in the age range for PSA screening, please do that. There are also more uncomfortable screening procedures, and sometimes this is important.

I understand it’s stressful when there may be false positives, in that you may have testing when there’s no cancer at all. Ask women about that and breast cancer.

But I believe many men aren’t doing any screening at all in the first place.

At the very least, if you’re in the key ages of 55-69, please do the screening.

If you have additional risk factors, consider starting younger or extending older.