Winston-Salem chronicle. (Winston-Salem, N.C.) 1974-current, October 22, 2015, Page A7, Image 7
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. ?