Canada’s screening silence is killing African Caribbean men slowly

When Movember rolls around, the promise of awareness shines brightly. Men grow moustaches; they talk, and they raise the necessary funds. Beneath the awareness lies a deeply disturbing reality that threatens the survival and stability of our communities, particularly the Black and racialized men we love: the abandonment of prostate cancer screening is driving rates of incurable disease up and pushing survival rates down.

As a strategic storyteller rooted in equity, and a community educator focused on social justice, I must ask: who pays the highest price when the healthcare system opts for silence?

The data is clear, sharp, and unforgiving. Prostate cancer is the most common cancer among Canadian men, accounting for 22% of all cancers (excluding non-melanoma skin cancers). It stands as the third leading cause of cancer death among men, behind only lung and colorectal cancers. The truly harrowing story lies in the trends following systemic decisions made a decade ago.

A comprehensive study led by Dr. Anna Wilkinson at the University of Ottawa, alongside colleagues from Statistics Canada and the University of British Columbia, analyzed nearly 40 years of data. Their research reveals the profound impact of the Prostate Specific Antigen (PSA) blood test. After PSA screening was introduced, prostate cancer mortality dropped by over 50%, with the most significant impact seen in men in their late 50s and 60s.

“Who pays the highest price when the healthcare system opts for silence?”

Yet, in 2012, based on concerns about overdiagnosis and subsequent overtreatment, PSA testing was largely abandoned. The Canadian Task Force on Preventive Health Care (CTFPHC) has, in fact, never recommended PSA as a screening tool.

The consequence of this abandonment is stark: the rate of stage IV, or metastatic (incurable) cancers increased by approximately 50% among men aged 50-74. These rising numbers represent families shattered, lives curtailed, and a significant financial burden on the healthcare system. Overall survival is dropping despite advances in testing and treatment.

This reversal of progress is fundamentally an issue of equity and access, which directly impacts the Caribbean community and other racialized groups whom we serve. The source research explicitly states that the current status quo (where organized screening programs are absent and U.S. recommendations against testing are mirrored) has created a system defined by inequity.

Dr. Wilkinson explains that the “Silence surrounding this issue drives inequity and inappropriate use and leads to poor health outcomes.” In the absence of system-wide guardrails, access to life-saving early detection is reserved for those who can navigate the complexities of the system. Only men who can “Self-advocate, who have a provider, and can afford the test can access it,” even having to pay for the test in provinces where access is restricted.

“Silence surrounding this issue drives inequity and inappropriate use,”

For members of the Caribbean diaspora, a community that often faces systemic barriers in accessing primary care, experiences chronic health concerns at higher rates, and may encounter cultural or linguistic challenges in self-advocacy, this lack of organized screening is a betrayal. When early detection is made contingent upon navigating bureaucracy and having the disposable income to purchase a test, it disproportionately harms those who are already struggling against systemic disadvantages.

We are not stuck relying on outdated practices. The solution lies in demanding “contemporary smart screening with a priority placed on optimizing benefits and reducing harms.” Modern screening has evolved, incorporating advances like MRI and active surveillance to dramatically reduce the need for biopsy and intensive treatment that sparked the initial fears of overtreatment.

It is time we move past judging PSA screening based on “outdated data and practices” and focus on strategies that are safe, effective, and, most importantly, equitable.

We, as a community, must transform this silence into fierce advocacy. We must demand that health systems prioritize the lives of our fathers, brothers, and sons. We must demand organized, culturally sensitive, and financially accessible contemporary screening programs. For the Caribbean community, this is a matter of survival, cultural empowerment, and profound social justice. We deserve to sound clear, powerful, and real about what we need to stay alive.