22 April 2024 – In Miami's Little Haiti neighborhood, a fleet of 4 RVs repeatedly shows up in parking lots outside churches, libraries and other locations. These mobile screening units, sometimes called “man vans,” offer prostate cancer screenings and education to achieve patients who lack access to solid health care.
The idea of targeting men and inspiring them to get really helpful cancer screenings and education originated in Miami in 2018 and was promoted by the University of Miami's Sylvester Comprehensive Cancer Center. Prostate cancer was added about 6 months ago and about 400 men have been screened up to now. An analogous program was launched in New York City in 2022 through the Mount Sinai Tisch Cancer Center, while countries from England to Brazil to Uganda have also experimented with ways to bring screenings to the people.
In Miami, it seems, the vans are a great method to conduct a test that sometimes does more harm than good. Because the query of whether a person needs to be screened for prostate cancer is complex. And men who’re at higher risk for dangerous kinds of prostate cancer are the least more likely to get tested. The vans and the medical experts on board try to seek out these men.
Who needs to be examined?
Efforts to extend screening rates are necessary because a prestigious medical journal this month predicted that the variety of prostate cancer cases worldwide will rise by hundreds of thousands. In a seemingly understated advice, the authors suggested that these mobile screening units, sometimes called “man vans,” could help slow the estimated increase in prostate cancer cases, that are expected to double by 2040.
The recent report within the Journal The Lancet said black men needs to be targeted for a straightforward blood test, called a PSA test, starting at age 45, and other populations might be targeted between ages 50 and 69. The tests would have to be done together with education and outreach programs, the authors wrote, but in addition said a lot of these mobile screenings are a possible tool for an increasing variety of communities with limited access to health care.
Brandon Mahal, co-author of the report and an associate professor on the University of Miami, found that black men have twice the danger of developing prostate cancer in comparison with the overall population. Men at high risk of prostate cancer, he said, include those that:
- Identify as Black, especially people of West African descent
- You come from a family with a history of prostate cancer
- You come from a family with a history of breast or ovarian cancer
- Do you’ve got a genetic risk factor, BRCA mutation
An easy blood test is step one in detecting the disease at an early stage when it’s most treatable. The evaluation, called a PSA test, looks for a protein called prostate-specific antigen, which might be produced by each cancerous and non-cancerous tissue within the prostate. The prostate is a gland that plays a job in men's hormonal, reproductive and urinary functions.
The problem is that the PSA test alone cannot at all times distinguish the very dangerous kinds of prostate cancer from the categories that men may have the ability to live with their entire lives with none problems. And when people hear the word “cancer,” they often seek treatment that some experts say is unnecessary and carries risks resembling impotence and infertility.
A Paper A study published last 12 months in a prestigious British medical journal concluded that the PSA test “remains highly controversial because it is unclear whether the benefits of reduced prostate cancer mortality outweigh the harms of overdiagnosis and overtreatment.”
“Don't get a PSA test or a biopsy unless you're comfortable with knowing you have cancer and not getting it treated,” said Dr. Andrew Vickers, lead creator of the British study and a biostatistician at Memorial Sloan Kettering Cancer Center in New York City.
This is because for prostate cancers that are usually not causing symptoms, are small, haven’t spread outside the prostate, and are more likely to be very slow-growing, many doctors recommend approaches resembling energetic surveillance, remark, or watchful waiting.
The current PSA testing advice within the United States is that men ages 55 to 69 should check with their doctor in regards to the advantages and risks of a PSA test. But Mahal and his co-authors of the brand new recommendations in The Lancet argue that it’s price strongly recommending screening for high-risk groups resembling black men.
“These men are the least likely to undergo PSA screening. This is most likely because they do not have better access to health care, less access to primary care services that could offer screening, or less access to primary care providers who understand that this population may be at higher risk,” Mahal said.
He called the present advice within the U.S. “not a very strong statement” and noted that it could be difficult for primary care providers to maintain up with a variety of changes in recent times. website The task force developing the recommendations says further changes are being considered, perhaps including changes based on age, race, ethnicity or family history.
“Cancer screening recommendations are based on benefits to the population, not to individuals,” explains Erin Kobetz, PhD, MPH, professor of medication and public health sciences on the University of Miami. “It's a public health management strategy, so sometimes those recommendations change, because while there may be benefits to doing a particular test for a high-risk person or a specific group of high-risk people, recommending it for everyone within a certain age range can create more problems than it's designed to solve. PSA is one of those problems.”
Current figures indicate 1 in 8 men within the USA develop prostate cancer, which is the second leading explanation for cancer-related deaths in men after lung cancer.
The possible changes being considered by the influential US Preventive Services Task Force suggest that the duty force may once more try to seek out a greater balance between the hazards and potentially life-saving results of the PSA test.
Precision medicine meets PSA screening
A cancer screening at one in all Miami's mobile units is frequently a straightforward visit. The vehicles are designed to draw attention and are colorfully decorated by a famous Miami artist. The artwork generally is a conversation piece in itself.
The University of Miami Sylvester Comprehensive Cancer Center's mobile cancer education and screening vehicles are called “Game Changer Vehicles,” or GCVs. The teams of community medical experts speak English, Haitian Creole, and Spanish. Team members typically come from the identical communities they serve, and all share a natural willingness to assist.
“They know methods to have conversations a few sensitive topic like cancer in a way that takes socio-cultural [customs]they usually provide education in regards to the risks and advantages of screening,” says Kobetz, assistant director of outreach and engagement at the University of Miami's Sylvester Comprehensive Cancer Center.
The mobile teams use a popular electronic health record system called EPIC, but their version was developed specifically for this unconventional RV healthcare situation. The electronic health record allows patients to access their information and send messages to their healthcare team through a mobile phone app. The version developed specifically for the Game Changer Vehicles simplifies the process of entering a person into the record system, which is notoriously time-consuming in the medical field.
“We know that appointments can become an unnecessary hurdle, so we register people on site,” said Kobetz.
Health care workers spend most of their week in the RVs working in the communities, but they also spend an additional day or two a week calling patients to share test results. If they can't reach them, they send them registered letters or visit them at home to discuss the results. Sometimes they even accompany patients to follow-up visits.
Men who attend prostate cancer screening are also invited to take part in a research project led by Mahal that examines the role of genetics, the environment and individual lifestyle factors such as diet and exercise.
“One of the benefits of studying a disease as complex as prostate cancer in a city as diverse as Miami is that there are numerous different burdens. This will help us understand what increases the danger of this complicated disease,” he said.
Worldwide, medicine is working to achieve what it calls precision medicine, such as treatments for the specific characteristics of a person's disease or even personalized vaccines. The game changer vehicles are precision medicine and community health. It's an approach that focuses on one person at a time.
“There will at all times be cynics and critics,” Kobetz said. “We're approaching this from the attitude that we're not only providing screening, but in addition educating and hopefully changing the social and structural barriers to cancer prevention basically.”
Kobetz isn't sure her work can change overall cancer rates, but “I believe we've seen over time that when individuals are engaged and a part of communities, the way in which they perceive health and health-related research changes. And that's ultimately critical to creating a difference toward health equity.”