Dr. Adam Zolotor, an associate professor of family medicine at UNC-Chapel Hill’s medical school, was named president and CEO of the N.C. Institute of Medicine in March. The organization is an independent, quasi-governmental group charged with giving state leaders advice on health issues.
Zolotor talked with The News & Observer about prostate cancer earlier this spring. The conversation has been edited for brevity.
Q: I particularly wanted to get your thoughts on what could be done to close the mortality gap between black and white patients, and what is out there that might be helping now.
A: It’s a pretty complicated, messy issue. The first thing to say is that up until five years ago, or maybe three years ago, screening for prostate cancer was pretty common. It is becoming less common, and the U.S. Preventive Services Task Force does not recommend screening for prostate cancer.
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So, I think some people would say African-American men need more screening. The (task force) would tell you that’s not the right way to go, and I believe that’s true. I think we should be diagnosing prostate cancer based on symptoms, and I would pose to you that a usual source of care and a trusted physician or health care provider is the No. 1 thing we can do to get men diagnosed earlier and treated earlier.
... So, I didn’t give you a good solution. Among the things that are happening that might start to help bridge this gap are educating African-American men about prostate cancer symptoms and where to go for treatment. I think that certainly improving access to care, not only health insurance and the other kind of usual barriers, but also a relationship with a primary care medical home and a trusted source of care. ... I think that one of the problems is that for 20 years, the health education message around prostate cancer was, go get screened, know your PSA. And we don’t buy that anymore, and so there isn’t a good soundbite right now.
Q: A lot of people point to the complicated nature of the information you’re talking about, with those guidelines changing in 2012, as creating dangerous confusion, particularly for black men. Because if you look at the fine print, that change in the guidelines was based, for all practical purposes, on studies of white patients.
A: I think that’s a problem in many areas of medicine. But I would ask you, should we be testing and treating without knowing, or do we need to figure it out first before we start recommending testing and treating? The problem is, we put the cart before the horse 20 years ago, and we need to be careful because backing out later winds up being harder. Ideally, what we need to do is figure it out first.
Q: So you are clearly not saying that a universal recommendation for screening for African-American men is the way to go?
A: No. I would say that we don’t have enough information to make that recommendation. And I would rather not test and treat in the absence of information.