FORUM __
We need to help our children succeed
Brian L.
Pauling
Guest
Columnist
Students
across the
nation have
returned to
school and
are fully
engaged in
their classes.
Soon their
parents can
expect tu icvcivc a pi ogress report oi tneir
child's academic performance.
Some will be fine, meeting or exceed
ing expectations for their grade level.
Unfortunately, a significant number will
already have fallen behind. Their academic
success will be in jeopardy unless someone
intervenes. To parents, teachers, adminis
trators and community members, I say that
someone is us!
It's up to us to work as a cohesive and
collaborative support system for our chil
dren. That will mean holding ourselves
and each other accountable to ensure that
each student has been taught and has
learned the required coursework for their
grade level and is ready to advance to the
next grade, without remediation, by the
end of the school year.
We are expecting a lot from our chil
dren, but what, in turn, should our children
expect from us?
As parents, students should expect us
to be actively involved in their education.
We must ensure the learning-readiness
basics are mastered at home: sufficient
sleep, on-time school arrival, safe after
school care and quality homework assis
tance, provided either by us or someone
we find to help, such as a student in a high
er grade, a college student, or a nonprofit
organization, like 100 Black Men of
America Inc., whose local chapters offer
mentoring and tutorial programs.
Then we must move to an even higher
level of engagement. For instance, we
should communicate regularly with our
child's teachers. Join the Parent Teacher
Association (PTA) at our child's school.
Attend school board meetings. Advocate
for the needs of our children, their school,
teachers and district. Educate ourselves
about the best available education options
in our communities, from traditional pub
lic schools to nonprofit charter schools.
If students do their part and we as par
ents do ours, then our children also should
expect their teachers and administrators to
provide instruction, experiential learning
opportunities and school environments
that breed and boost success. Our children
should expect their teachers to demon
strate that they believe that all children can
learn at high levels. When some children
fail to make the grade, they should expect
that their teachers and school staff won't
let them flounder, but use proven interven
tion strategies to get them back on track.
Our children should expect their teachers
to be capable and well-trained profession
als who teach in compelling and creative
ways.
Our students should also expect the
support of people in their communities,
even those without school-aged children,
because these students are destined to
impact the community through their posi
tive contributions or negative degrada
tions. Visit a local school and ask how you
can volunteer. Partner with a local school
and offer your services or the expertise and
resources of your company or organiza
tion. Serve on a local school council. Get
involved as a tutor, mentor, guest speaker
or member of a booster club. Stand with
school boards and policy-makers to advo
cate publicly for high-performing schools
and better teacher evaluations and student
assessments. All are vital ways community
members can support our students' overall
success and make a difference in their
lives.
We at 100 Black Men of America Inc.
know that our children are more than capa
ble of being academically successful. Let's
provide access to educational opportuni
ties that equip students to be competitive.
Let's set high expectations for student
achievement, remove obstacles to progress
umine rue pnwo
and provide proper interventions and sup
port systems. We will demonstrate our
unwavering belief in our students by work
ing side by side with other concerned par
ents, teachers, administrators and commu
nity members throughout the school year.
Let's put our children's needs before poli
tics and make our nation's schools the best
they can be, so all of our students can
become the best they can be.
Brian L. Pauling is the national presi
dent and CEO of 100 Black Men oj
America Inc., which was founded in New
York City in 1963. Today, the organization
has more than 100 chapters in the United
States, England and the Caribbean. Its
dedicated members form an international
network of mentors focused on creating
educational opportunities, promoting eco
nomic empowerment, addressing health
disparities, and creating positive, nurtur
ing mentoring relationships that extend
across a lifetime. Visit www.lOOblack
men.org to learn more.
Debate swirls
about screening
for prostate cancer
Armin
Brott
I Guest
Columnist
If you ask Bernie
Wooden, he'll tell you
straight out that a simple
blood test saved his life.
The test in question is the
PSA (for prostate specific
antigen) and Wooden, a 68
year-old African American
man living near
Washington, DC, had been
getting it done every year.
"My doctor had been
comparing my PSA levels
from year to year," he says.
"After one of my physicals
he calls and tells me that
the levels had gone up
since the year before, and
he referred me to a urolo
gist."
The urologist ran some
tests, took several small tis
sue samples, and found
seven cancerous tumors.
Bernie Wooden's story
is hardly unique. The PSA
used to be given to men
fairy routinely. And men
around the country - and
the world - believe they're
alive today because their
doctor noticed a sudden
increase in their PSA lev
els.
But in 2012, the U.S.
Preventive Services Task
Force (USPSTF) issued a
recommendation against
doing PSA screening fot
prostate cancer, saying that
the harms of the test out
weigh the benefits. That
recommendation ignited a
huge - and not always civil
- debate among people
who work in men's health.
Some supported the
USPSTF recommendation
saying that prostate cancel
typically grows very slow
ly and men are more likely
to die with prostate cancel
then from it, the PSA tes
leads to over diagnosis,
and an abnormal PSA test
could drive a man to pur
sue unnecessary treatment
or surgical procedures.
Side effects, many of
which are permanent,
include urinary inconti
nence, erectile dysfunction,
and bowel dysfunction.
Proponents of the PSA
test point out that prostate
cancer is the most common
non-skin-cancer in men,
and that while some
prostate cancers are slow
developing, others are
extremely aggressive.
They also note that only
healthcare professionals
can order surgery or other
treatments and that not
having PSA measurements
removes an important data
point that could help men
and their providers assess
the patient's risk, evaluate
all of their options. In some
cases, including Berne
Wooden's, that treatment
? 1 UaIii/Ia wa/4lool
pian imgiii mciuvit iiivuivtu
procedures such as radia
tion and surgery. For oth
ers, the best approach is to
simply "watch and wait,"
also called "Active
Surveillance." In either
case, the decision is made
by the patient, his family,
and his doctor.
More accurate diag
nosis techniques are help
ing.
When evaluating the
L risks versus rewards of a
particular health screening,
? experts often look at the
number of patients who
would have to be screened
in order to save one life.
, For prostate cancer, that
I number used to be very
. high. However, thanks to
more accurate diagnosis
. techniques and looking at
the impact of screening at
r longer time points, the ratio
of screenings to lives saved
, is now in the same range
r for prostate cancer as it is
t for breast cancer. And
while the Task Force rec
ommended fewer mammo
grams for women, they
didn't go as far as recom
mending that they not be
done at all.
The big question is
whether getting a PSA test
will help men live longer.
According to the USPSTF,
"the precise, long-term
effect of PSA screening on
prostate cancer-specific
mortality remains uncer
tain." Dr. Steven R.
Patierno, a professor at the
Duke University Medical
Center and Deputy
Director of the Duke
Cancer Institute, agrees
that more research is need
ed, but he disagrees with
the recommendation
against using the PSA
screening at all.
New studies are
already showing that, as a
result of the USPSTF's rec
ommendations, fewer men
are being screened for
PSA, and there is signifi
cant confusion among
Primary care rnysicians
about whether or not to
recommend screening to
their age-appropriate
patients. Using other tools,
doctors are still able to
diagnose prostate cancer.
The biggest concern is that,
instead of catching the dis
ease before it becomes
symptomatic, they may
now start seeing patients
for the first time in a later
state of the disease or who
have already developed
severe symptoms.
"If they wait until they
have blood in their urine
before they come in," says
Patierno, "at that point,
treatment options are more
limited."
There's no question in
Bemie Wooden's mind that
he would have been one of
those men. He had none of
the traditional symptoms of
prostate problems: he was
n't getting up multiple
times at night to urinate; he
didn't have blood in his
f
urine; he wasn't overly
tired or thirsty; he didn't
have erectile difficulties. In
fact, he felt just fine.
Without those regular PSA
tests, his cancer might not
have been detected until it
was too late.
So what should be
done?
One problem with the
Task Force's recommenda
tion is that it didn't ade
quately take into account
high risk individuals,
including African
American men as a whole
and any man who had a
close relative (father or
brother) who died of
prostate cancer.
For Patierno, the big
issue with the PSA isn't
over screening or over
diagnosis.
"It's what you do with
the information once you
have a suspicious finding."
His own recommenda
tions are generally in line
with those published in
2015 by the National
Comprehensive Cancer
Network (NCCN).
Men who are in a high
risk group (African
American, family history
of prostate cancer, or con
firmed BRCA1 or BRCA2
genetic mutation) or who
are interested in screening
should get a PSA test and
digital rectal exam at age
40. Those will be a base
line for future tests. If the
PSA is 1 or greater, the
patient should receive
annual follow-ups. If the
PSA is less than 1, the
patient should have a fol
low-up screening at age 45.
All men 50 and over
should have PSA screen
ing, with the frequency
guided by PSA levels.
Increasing evidence indi
cates that if the PSA level
is less than 1, the chance of
dying from prostate cancer
is negligible. But if it's
between 1 and 3, the risk is
much higher. Those men
should get "active surveil
lance," which means regu
lar PSAs (usually no more
than once every six
months) to track whether
or how quickly the disease
is advancing. The only way
to do that is if you have a
baseline test. Increasingly.
Active Surveillance proto
cols include more sophisti
cated imaging methods of
detecting prostate cancer
and distinguishing aggres
sive from indolent prostate
cancer.
As a diagnostic tool.
PSA testing is most effec
tive for men 55-69. Older
men (over age 75) or those
with a life expectancy of
less than 10 years should
probably discontinue PSA
screening.
I
If the results of the PSA
concern the healthcare
provider, it's time for a
heart-to-heart to determine
the best course of action.
The first step will undoubt
edly be to confirm the PSA
results with a digital rectal
exam (DRE), MRI, ultra
sound, or, in some cases, a
bionsv.
As far as treatment, in
many cases, it starts with
active surveillance.
Beyond that, "we're get
ting more and more sophis
ticated in our ability to
identify whom to treat,
whom not to treat, and
what treatments to
choose," says Patierno.
Bernie Wooden sug
gests that if a man is
referred to a urologist or
other specialist for addi
tional tests, he take a rela
tive or close friend along.
"After the doctor said
the word 'cancer,' I didn't
hear anything else," he
says. "Fortunately, my wife
was paying close attention
and she was able to fill me
in after we got home."
For more information
on PSA screening, prostate
cancer, and treatment
options, visit
wwwprostatehealthguide .c
om and Men's Health
Network at menshealthnet
work.org.
?