Fighting back against prostate cancer in Scotland County

By Ben Rappaport 

Greg McMillan’s barber shop in the northeast corner of Scotland County is more than a place to get a fresh lineup and a clean shave. It’s a community space where people share everything from tall tales to heart-to-hearts.

McMillan’s shop in Wagram, Next Cuts, hosted Cuts and Conversations on Saturday in partnership with the Prostate Cancer Coalition of North Carolina. The event was meant to spread awareness about prostate cancer and its impact on Black men in rural communities.

“This is my community chair,” McMillan said, clippers in hand. “And anything you want to say in it, from girl problems to cancer, I’ll listen.” 

Scotland County was the first county to pilot the Cuts and Conversations program in North Carolina. The county also became one of eight in the country to pass a proclamation making June Men’s Health Month at a recent commissioners’ meeting.

Racial disparities

The event was organized by local resident Mary Anderson, who also serves as executive director of the Coalition. Anderson said the program is built on the idea that barbers can be community health ambassadors

“The barbershop is often a forum of discussion, especially in the Black community,” she said. “We want to provide an environment that can inspire communities to come together for awareness about this often taboo topic.”

Anderson said she hopes the program will be replicated across the state and adapted to fit the needs of each local community. 

Prostate cancer is the second leading cause of cancer deaths for all men, according to the Prostate Health Education Network. It is the most common cancer among Black men. Almost all men who are diagnosed early, before the cancer has spread, survive for five years or more. But the survival rate drops to  34% when detection occurs after the cancer has spread, according to the UNC School of Medicine. 

In North Carolina, the rate of new prostate cancer cases is 124 per 100,000 men, the 11th highest rate in the country, according to the National Cancer Institute. Black men are 2.3 times as likely as white men to die from the cancer in North Carolina. 

The Border Belt region — Bladen, Columbus, Robeson and Scotland counties — is largely on par with statewide averages for new cases. Scotland County’s new case rate is 87 per 100,000 men.

Deaths, however, are higher than the state average in Bladen and Robeson counties, with 26 deaths per 100,000 men. 

The racial disparities in prostate cancer are a result of genetics, access to health care and socioeconomic status, according to a 2022 study published in the National Library of Medicine. The study suggests “immediate actions are needed” to bridge the gap between social and biological factors that cause prostate cancer disparities.  

A holistic approach

The event at Next Cuts featured pamphlets about cancer screenings and the importance of early detection. Scotland Family Counseling Center also offered mental health resources curated for men, including literature on fatherhood, grief and therapy.

For Anderson, the fight against prostate cancer began in 1996 when her father, Bob, was diagnosed at the age of 53 and died seven years later. He became an advocate for prostate cancer awareness and created the coalition his daughter runs today.

Mary Anderson is executive director of the Prostate Cancer Coalition of North Carolina. Photo by Ben Rappaport

“I made a promise to him to keep this work going,” Anderson said. “Our work is to be advocates for the men who have cancer, not the cancer. That means taking a holistic approach.”

While getting men to talk about their genital health can be a barrier, Anderson believes frank conversations and leaning into discomfort are the best way to start. At the event, she handed out lanyards with walnuts on them, meant to represent the prostate, and made jokes about regularly checking testes for cancer.

This comfortability is invaluable to getting men of all ages thinking about testicular and prostate cancer, Anderson says. While testicular cancer is much less common and less deadly than prostate cancer, it is most common among men aged 15 to 35, according to the Testicular Cancer Foundation. The most common age range for prostate cancer is 50 to 79, but often more fatal in men 40 or younger.

“As they're exiting the high-risk age for testicular cancer,” Anderson said, “they're entering the high-risk age for prostate cancer. It creates a comfortable transition if you can get them talking about it earlier.”

When detected early, 99% of men survive testicular cancer. North Carolina’s testicular cancer rate, 5.1 per 100,000 men, is lower than the national average. Each of the four Border Belt counties had fewer than 16 cases of testicular cancer between 2016 and 2020, according to the North Carolina Center for Health Statistics

Anderson said these conversations are especially valuable in rural communities like Scotland County because awareness programs are often targeted toward more populated areas. Other counties including Cumberland, Durham and Onslow are set to follow Scotland’s lead with their own Cuts and Conversations events throughout the month. 

Greg McMillan talks with a customer at Next Cut. McMillan says he aims to make his barbershop a community space for all types of dialogue. Photo by Ben Rappaport