EONS Magazine Winter/Spring 2019 edition

Prostate cancer risk – How the body and illness are differently understood as a construct of socialised understanding

Sarah Fry on: Perceptions of prostate cancer risk in White Working Class men, African Caribbean men and African men living in South East Wales: A constructivist grounded theory

Sarah Fry

Sarah Fry

The lifetime risk for prostate cancer is 1 in 8 for all men (Mackie 2010). The risk for black men of African or African Caribbean origin is 1 in 4 (UK National Screening Committee 2014). These men are also more likely to be diagnosed with an aggressive form of prostate cancer and have a higher mortality rate when compared to all men (Benerif and Eeles 2016). Despite this increased risk, prostate cancer diagnosis remains low amongst men of African and African Caribbean origin (Odedina et al. 2011).

In Europe and America, the apparent low diagnosis rates amongst black men may be because black communities are disproportionately represented in areas of deprivation, where cancer outcomes are known to be worse (Shi et al, 2013; Surbone and Halpren 2016). It is also possible that black men have the additional burden of maintaining their masculine status in ways that other men don’t.  Black men experienced emasculation, during the period of migration for work, and writers on black musicality suggest that maintaining the image of a fit and well body is important to these men, to fulfil their socialised need to be masculine (Staples 1995).

Mind map of the body in society

Grounded theory

To study possible differences in constructions of understanding for prostate cancer risk, research was carried out using a constructivist grounded theory. Men without prostate cancer from African and African Caribbean (Black men) communities, and men from White Working Class communities were asked to take part in semi-structured interviews based on their experiences of cancer, their understanding of prostate cancer and how they would prefer to be educated about prostate cancer risk.

The men spoke differently about how they socially constructed their understanding of prostate cancer risk and the importance of the body in a social context quickly became relevant. For the black men, a healthy body symbolised freedom and masculinity and was talked about in the context of their community. For the White Working Class men, a decline in the health of the body was seen as an acceptable part of ageing, and these men talked about their risks for illness as an individual concern, rather than related to other similar men in their community. These themes were the most central to the interviews.

Somali men

Somali men

To explore these themes in more depth, focus groups were conducted to examine possible differences in the way men spoke to each other about prostate cancer. These data showed that whilst talking as a group the black men spoke about prostate cancer as an abstract concept; something that could happen to men from their community but without reference to themselves, even in an anonymous context. There was a strong feeling that men should help each other but this was talked about as a community concern and not related to their own need to understand risk.  Conversely, the White Working Class men spoke to each other about prostate cancer in a competitive way. The men willingly shared their experiences of seeing a doctor and became spirited when establishing who was the most unwell. These data are a demonstration of how the body and illness are differently understood as a construct of socialised understanding. 

This research has shown that we need to consider how men frame their understanding of prostate cancer based on the way they have been socialised to understand the body. Understanding the social history of how the body is understood could help healthcare professionals and third sector organisations effectively educate and engage with the men at the highest risk for prostate cancer.

Sarah Fry is a lecturer (Adult Nursing) in the School of Health Care Sciences in the College of Biomedical and Life Sciences at Cardiff University, Wales.