The authors aimed to evaluate whether there is a racial difference in stage at presentation of prostate cancer among men who use the Veteran Affairs (VA) medical care system. Since the VA treatment system theoretically provides equal access to treatment across economic groups, this evaluation aimed to shed light on whether the reported racial differences in stage of presentation of prostate cancer is due to socioeconomic status (SES) or access differences between blacks and whites. This study used the Detroit Cancer Surveillance System and data from a local VA medical center from 1973 to 1992.

Blacks were slightly less likely to have presented with "local stage" cancer than white men (54% versus 57%) and were significantly more likely to have presented with "distant stage" cancers (25% versus 19%). The pattern was the same when year of diagnosis was divided into two ten-year time periods. Among the 44% of the sample for whom follow-up data were available, a
“survival analysis showed that, in patients less than 65 years, whites had better 5-year survival (p=0.011) and in patients older than 65 years, blacks had better 5-year survival (p=0.164).” Once stage of presentation was taken into account, survival rates did not differ significantly for blacks and whites, but the trends were the same. The authors offer two possible explanations for the age crossover in mortality – (1) older black men may represent a group with slowly growing cancer who remained alive compared with a group with rapidly growing cancer who died younger, and (2) white men may experience malignant transformation to clinically significant prostate cancer at a later age. The study did not examine whether the racial difference in stage of presentation of disease was responsible for the racial difference in survival.

The authors state that "even though screening or early testing is controversial, it may be appropriate for African Americans as a high-risk population." Given the persistence of racial differences in stage of disease at presentation and mortality rates in a theoretically financially equal-access system, the authors "propose that [the] negative attitudes and behaviors toward the heath care system [that were suggested by a study based on an early detection program in Detroit] are responsible for delays in diagnosis, and are major contributors to the presentation of advanced prostate cancer in African -American men resulting in poorer survival." They add, "other possibilities also exist, such as genetic and environmental factors."