California lawmakers should address health disparities, stem rise in prostate cancer

As California continues to grapple with the present effects of the Covid-19 pandemic, we are also beginning to consider the longer-term health impacts, including the significant percentage of Californians that delayed or avoided medical care due to concerns over Covid-19. The result is that, despite the availability of effective tests and innovative medicines to treat many chronic conditions and life-threatening diseases such as prostate cancer, the number of those affected continues to grow. To help prevent unnecessary deaths from prostate cancer, the California Assembly should take action to increase access to early detection and screening services, particularly for underserved and vulnerable communities.

Prostate cancer is the second-leading cause of cancer deaths among men in the United States. Although one in eight men will be diagnosed with prostate cancer in their lifetime, the odds increase to one in six for Black men, and one in three for men with a family history. The American Cancer Society projects that there will be 25,880 new cases of prostate cancer in California alone this year, making it the highest incidence of prostate cancer in America.

At the hospital where I treat patients—Watsonville Community Hospital—I am the only prostate cancer surgeon. My patients come from all over the Central Valley coast, but many are from neighboring farming communities made up of underserved migrant populations. Many of my patients barely speak English and often only visit me once their cancer has progressed. 

I am a Filipino-American man who grew up working as a laborer and a son of a disabled veteran father who could have died when he was diagnosed with tuberculous. I lived among the underserved and witnessed the health hardships of many. Their lives affected the mission I now live by—support and care for the most vulnerable by advocating for early detection of disease. 

Existing California law requires health insurance policies to provide coverage for the screening and diagnosis of prostate cancer, but the cost of these services often deters or prevents high-risk populations from seeking care and detecting early-stage prostate cancer.

Fortunately, the California Assembly is currently considering legislation to help address these disparities and make prostate cancer screening more broadly accessible. Assembly Bill 1520 (AB 1520), co-authored by Assemblymember Marc Levin (D–Marin County) and Senator Ben Allen (D–Santa Monica), would prohibit health insurers from applying a deductible, copayment or coinsurance for prostate cancer screenings for men over the age of 55 and high-risk individuals over the age of 40. Black men, those with a family history of prostate cancer, those with a genetic predisposition, and veterans are those most likely to be at high risk. 

The impact of early screening and detection on conditions such as prostate cancer is irrefutable: early detection and diagnosis increase the likelihood of effective treatment and achieving remission. In 2017, the California Assembly passed AB 1795 and AB 1763, which provided no-cost early detection screening and diagnosis services for breast cancer and colorectal cancer. AB 1520 would level the playing field and help the state effectively combat the rise in prostate cancer, which claims a man’s life every 15 minutes. I urge state policymakers to support this common-sense legislation that would immediately help save lives in California. 

Peter N. Bretan, Jr, MD, FACS is the past president of the California Urology Association and the current president of the California Medical Association. Dr. Bretan lives in Santa Cruz County.