Dr. Ruth Petersen is the chief of the Chronic Disease and Injury Section of the N.C. Division of Public Health. She talked with The News & Observer earlier this spring. The interview has been edited for brevity.
Q: Several experts on cancer and public health have suggested things they think could help close the gap in prostate cancer mortality between black and white men. Several have mentioned the idea of expanding the state’s Breast and Cervical Cancer Screening Program – which pays for screening low-income women for those cancers – to include prostate cancer. Is that feasible?
A: So, can prostate cancer be added to that program? No, because of the federal guidelines that I’m needing accountability to the federal government and the General Assembly. But, could prostate cancer be similarly funded? Yes, but there is no federal funding stream to do that. So, the state could do that if it chose to.
The problem you get into is balancing the prevalence and the incidence and health disparities of our other cancers, and their preventability. So when you look at the mortality rates in North Carolina for cancer for all populations and not just African-American men, the cancer that’s the leading cause of death is lung cancer. So lung cancer is caused by either smoking or radon, so you get into this interesting balance. With the state’s limited resources, where would you put the money? Lung cancer prevention, radon prevention, or would you put it in prostate cancer prevention?
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Q: For practical purposes, this is a different disease for black men. And it just seems like the deliberation of where you would put the money, if you had money, would have to take into account that disparity.
A: It is a different disease. But look at Native Americans, they are many times more likely to die of lung cancer. So the disparities are ...
Q: I’m not saying that prostate would come out the winner in some theoretical battle for $10 million, money that of course doesn’t exist, just that it seems like that data is part of the equation. New York funds it, treatment for prostate cancer, but they don’t fund the screening, because the guidelines from the federal advisory panel said don’t do PSA testing.
A: There are a lot of questions about screenings and prostate cancer. Its a hugely complicated area, and that makes every decision harder. That’s where you get into what’s a public health investment and what’s a medical investment. So prostate screening of any male that is appropriate based on risk factor and age, should that be a covered by an insurance policy or a fund that covers people who don’t have insurance? That’s a whole separate issue.
Q: How does the funding work for the breast and cervical cancer treatment here for patients diagnosed under the state screening program?
A: We have an arrangement with our Medicaid program. So if those folks screen positive and they need further workup, we have an arrangement with our Medicaid agency that they will take care of those costs for treatment because the last thing we wanted to do in the state is identify a bunch of people who have breast and cervical cancer potentially and have nowhere to send them.
Q: If I were to talk with the head of the state association of county health directors, or state public health association, I’m sure that person will tell me they don’t have the resources, that they aren’t funded for doing outreach work, and they don’t have the money, or the people with these volunteer panels, to reach the people in the county for the health education component of this, right?
A: You’re right; that’s how they would answer you. And they don’t get enough money. But they do get a little bit of money and they decide, with their community, what their biggest health issues are. And many of them right now are really prioritizing diabetes among the African-American population.
Q: With prostate cancer, who could step forward and help with that?
A: Well, with prostate, again it would be our safety net providers. So, free clinics, Medicaid provider practices … that are willing to have some folks who don’t have any insurance. So they generally have to have four paying people to keep their doors open, four for every person without insurance.
So, those would be the negotiations that I’d have with state level agencies about how to do this. But I have to do this with every other disease, too, so we have to patch these things together a little bit and try to figure it out.