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By John Schieszer
Medical Minutes 

Prostate cancer screening is lacking for Alaska Native men

Also: Using humor for improved personal and social wellbeing


August 1, 2023 | View PDF

Alaskan Native men warned about lack of screening for prostate cancer

Men in Alaska age 50 or older may want to discuss prostate cancer screening with their healthcare provider. A new study from Wake Forest University School of Medicine is suggesting that American Indian and Alaska Native men are less likely to be screened for prostate cancer compared to other racial/ethnic groups and it is coming with a high price tag.

The study appears in the online journal called Cancer Causes & Control, and it points out the importance of barriers to good care and how best to overcome those barriers.

“Our findings highlight a significant healthcare disparity in accessing care,” said Chris Gillette, who is an associate professor at Wake Forest University School of Medicine and the principal investigator of the study.

According to the American Cancer Society, there are more than 34,000 prostate cancer deaths in the U.S. each year, and prostate cancer is the second-leading cause of cancer death in men. American Indian and Alaska Native men are less likely to be diagnosed with prostate cancer. However, their prostate cancer outcomes are much worse than other racial/ethnic groups, especially for men age 50 to 59 years old.

There are two tests that can help diagnose prostate cancer. One is a digital rectal exam (DRE), and the other is a blood test that measures the amount of prostate-specific antigen (PSA). Elevated levels of PSA in the bloodstream can be indicative of prostate cancer.

For the study, researchers conducted a secondary analysis of the National Ambulatory Medicare Care Survey (NAMCS) datasets from 2013 to 2016 and 2018 and the NAMCS Community Health Center (CHC) datasets from 2012 to 2015. NAMCS is a nationally representative sample of visits to non-federal office-based physician clinics. The CHC samples include outpatient visits to physicians, physician assistants and nurse practitioners at community health centers including federally qualified health centers and Indian Health Service clinics.

In the NAMCS dataset, researchers analyzed 509.7 million visits over a five-year period, of which 232,998 were for American Indian and Alaska Native men.

“We found that American Indian and Alaska Native men were significantly less likely to receive a PSA than non-American Indian and Alaska Native men,” Gillette said. “The most alarming finding is that there were zero instances of DREs in the NAMCS dataset over the entire five-year period, and there were no PSAs conducted in American Indian/Alaska Native men after 2014.”

In the NAMCS dataset, the rate of PSAs being ordered for American Indian and Alaska Native men was 1.67 per 100 visits but included no DREs. In analyzing the CHC dataset, the researchers found that American Indian and Alaska Native men had slightly lower rates of PSAs than non-Hispanic White men, but the difference was not statistically significant.

“We found that the disparity may not exist when men visit community health centers,” Gillette said. “More research is needed to better understand why.”

Currently, American Indian and Alaska Native men experience disproportionately greater prostate cancer mortality compared to other racial and ethnic identities. Men from Alaska often present for care when their prostate cancer is more advanced compared to other racial and ethnic groups, which may be a direct result of not getting PSAs and DREs at the same rate as other groups.

Laughter and humor for improving wellbeing

Telling a few jokes may be better for your health and others, and even much more so than ever realized. It turns out that laughter and humor are potent tools that can significantly impact our wellbeing, according to new research conducted by the University of Warwick in England.

The researchers studied laughter and humor in both the workplace and in health-related circumstances and found that these two elements possess remarkable properties that can alleviate worry, diminish feelings of isolation, and instill a sense of control over one’s mental and emotional state. Humor and laughter can act as a natural pressure valve.

“Laughter is an important channel to express feelings, show appreciation and create a positive atmosphere. Similarly, by embracing humor, individuals can find solace and resilience in the face of adversity,” said Stephanie Schnurr, a professor of Applied Linguistics at the University of Warwick.

Laughter and humor play a crucial role in enabling individuals to cope with novel and potentially overwhelming situations, and to create healthy and happy relationships. Humor provides an avenue to express the unsayable, allowing individuals to discuss topics around social, economic and environmental issues that are typically considered taboo, such as financial issues, mental wellbeing and death.

Schnurr said laughter and humor can be incredibly effective tools for providing a mental break from life’s challenges. They allow individuals to adopt a more light-hearted viewpoint toward their circumstances. By finding humor, and even laughing in difficult situations, we can remind ourselves and those around us that the situation may not be as bad as we think.

She said laughing at disagreements and troubles among colleagues at work helps them to overcome these issues and lays the foundation for a more productive and collaborative working environment. Schnurr said laughter has the remarkable ability to empower us and give us a sense of control, transforming us from feeling like helpless victims to individuals in charge of our situations.

Laughing at and making fun of one’s outsider status in a work team is another example of this powerful function of humor. By embracing the power of humor and laughter, a person is able to navigate challenges with confidence. Moreover, laughter serves as a valuable outlet for emotional expression, promoting overall mental and emotional wellbeing, according to the researchers.

They contend that humor, especially when used with irony and sarcasm, plays a crucial role as a release valve, enabling individuals to effectively relieve stress and tension. By embracing the power of laughter, it is possible to lighten the weight of everyday challenges. Engaging in humorous exchanges allows a person to temporarily detach from the seriousness of life and work, offering a momentary respite and a fresh perspective.

It is also a chance to change your outlook on issues that impact overall well-being. In the medical context, humor is often used to put patients at ease, and used to tackle difficult or sensitive conversations, for example an unhealthy lifestyle or lack of engagement with the prevention and treatment plan.

“Humor creates a new version of reality that is easier to live in, less scary, and less likely to cause fear. Used by women in male-dominated professions to make fun of their outsider status, humor enables them to criticize and challenge the status quo without putting others off or offending them. Humor can also help people criticize their boss and communicate alternative views without running the risk of being shot down for disagreeing with the boss,” said Schnurr.

Laughing and having a sense of humor can help bring people together and build positive relationships. It can create a type of endearment. In the workplace, this is particularly useful in job interviews where creating a good relationship with the interviewers and signaling belonging are important for success. Although making fun of and laughing at someone could be hurtful, laughing with (rather than at) can show that you understand and like your colleague, and it can make both of you feel better and happier.

John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at

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John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute.

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