Lloyd Austin's Private Battle: Prostate Cancer, Stigma and the Impact on Black Men
When he was diagnosed with prostate cancer late last year, Defense Secretary Lloyd Austin joined the 280,000 Black men annually identified with the disease. It’s so common, studies show, that 1 in 6 Black men will develop it during their lifetime.
As he decided on treatment options, however, Austin -- a retired 4-star general, the Pentagon’s top official and 6th in line to the presidency -- made a common decision. He kept his condition to himself.
So when news broke in early January that Austin secretly had surgery in December, then was quietly admitted to the intensive-care unit in January for serious, post-surgery complications, it erupted into a national political scandal. The defense secretary had kept Congress, the White House and President Joe Biden in the dark about his condition.
Researchers who study the disease, however, say Austin’s secrecy is a hallmark of prostate-cancer stigma -- powerful feelings of shame or embarrassment about the disease centered on stereotypes about Black masculinity, including homophobia.
The Critical Importance of Early Detection in Prostate Cancer
Characterized by reluctance to even acknowledge the disease, the stigma has hardened into a culture of silence around a cancer that kills tens of thousands of Black men every year.
Indeed, researchers have found some Black men say they would rather die from prostate cancer than allow a doctor to probe their rectum, even though a few moments of discomfort and vulnerability could save their lives.
“I've lost track of the number of times I've heard men say they wouldn't let anyone do that to them, under any circumstances,” says Michael Arrington, a public health professor and prostate cancer researcher at Sam Houston State University in Huntsville, Texas.
“You have to wonder where it comes from,” he says. “People who are sick should want to get better, and they shouldn't worry about being perceived as less than whole.”
A common malignancy, prostate cancer affects the prostate gland, a small organ in the male reproductive system, and typically affects men as they approach middle age. Its aggressiveness, however, varies: some cases progress slowly and remain localized, while others involve cancer that has spread to other parts of the body.
“People who are sick should want to get better, and they shouldn’t worry about being perceived as less than whole.”
While the disease is treatable, with a high survival rate, early detection is critical, especially for Black men: they are nearly twice as likely to develop prostate cancer than white men, but more than twice as likely to die from the disease.
In late January, not long after news broke about Austin, Dexter Scott King -- the youngest son of Dr. Martin Luther King Jr. -- died after a long battle with prostate cancer. News reports indicate that, like Austin, King, 62, had kept his condition private while undergoing treatment. He died just 8 days before his 63rd birthday.
After undergoing surgery on December 22nd, Austin was quietly recovering at home over the Christmas holidays, but had to be raced by ambulance to Walter Reed National Military Medical Center on New Year’s Day in “extreme pain.” The defense secretary was admitted to the intensive-care unit for treatment and remained at Walter Reed for more than a week before finally informing the White House he was ill.
The Battle Against Prostate Cancer in the Black Community
When she heard about Austin, Motolani Ogunsanya, an assistant professor and prostate cancer researcher at the University of Oklahoma, wasn’t surprised. The defense secretary’s hush-hush approach, she says, “is no different” than what she’s heard from Black men she has studied and interviewed in her work.
Prostate cancer “has really been shrouded in silence within the Black community, says Ogunsanya, who has co-authored several medical papers on the issue. “Culturally, men are just supposed to show strength and resilience before vulnerability. With the digital rectal examination, it’s a fear that it is making them gay, or just being vulnerable” while a physician “is sticking a finger up it.”
Further, a significant cohort of Black men -- mindful of atrocities like the infamous Tuskegee Study, or bias they’ve experienced from white doctors -- don’t trust the medical system.
Although misguided, “those fears are real,” Ogunsanya says.
“Culturally, men are just supposed to show strength and resilience before vulnerability. With the digital rectal examination, it’s a fear that it is making them gay, or just being vulnerable.”
Arrington, the Sam Houston State researcher, says those fears stem from “a lot of what we are taught about masculinity from an early age.” They overlap, he says, with “some homophobic thoughts” that Arrington himself isn’t immune from.
Years ago, before his first digital rectal exam to screen for prostate cancer, Arrington says he was anxious despite “all my medical knowledge about why this is an important procedure and how there’s nothing threatening about it.” He calmed himself down with reminders that, while intrusive, the digital rectal exam was no big deal -- just a medical procedure to tell if he needed treatment.
In the waiting room of the doctor’s office, however, Arrington’s anxiety suddenly spiked: “All of those thoughts that I know are dangerous and inaccurate hit me out of nowhere.”
“I found myself thinking about an old Ray Romano stand-up comedy bit where he talks about his first prostate exam and how he had two worries,” Arrington says, recalling his thoughts with chagrin. “The first worry was that he wasn't going to enjoy it. And the second was that he would.”
For men, “it's embedded in our culture, in the jokes that people tell, in the juvenile humor that guys throw about with each other in the locker rooms,” Arrington says. “Is that fear? I would say absolutely -- a fear of the unknown.”
In Austin’s case, “we're talking about a hyper-masculine ideal of the strong virile warrior,” Arrington says, referencing Austin’s race, his military career, and his political power. Prostate cancer and all that surrounds it, he says -- including worst-case scenarios of post-surgery erectile dysfunction or incontinence -- “threatens those aspects of masculinity and not only virility and potency but strength.”
Credit: paulo.stuff | Shutterstock
The Path Forward in Prostate Cancer Awareness
Dr. Tamara Lamar Lothan, a urologic pathologist and professor at Johns Hopkins University, says it’s impossible to know exactly what caused Austin’s post-surgery problems, or if it will lead to long-term issues. But the surgery itself, she says, is “exceedingly safe” and complications like his are rare.
“It’s unfortunate,” says Lothan, whose university is home to the Schaufeld Program for Prostate Cancer in Black Men. “It'd be great to use this to raise awareness of the issue -- a very prominent black man is diagnosed with prostate cancer -- but I think people may get stuck” on Austin’s post-surgery problems.
“The last thing we want is for men to read into this, and be more reluctant to get treated,” she says.
Still, Lothan and others say the dark cloud of scandal around Austin may have a silver lining: the issue of Black men and prostate cancer, as well as the stigma around it, made national headlines. It’s likely to get more scrutiny if Congress follows through on its vow to make Austin publicly account for his secrecy.
“His case, I think, presents such an interesting opportunity” to shed the homophobia around detection and fears of treatment, Arrington says. Already, he says, initiatives such as training barbers to talk about it with their clients are already having an impact, using trusted community voices to break down stigma.
“It can do a world of good if we can get the Austins of the world to speak up,” Arrington says. “He can acknowledge this as an important health issue, and talk about the steps we can take to treat it, and encourage people to get tested early.”
“It can do a world of good if we can get the Austins of the world to speak up. He can acknowledge this as an important health issue, and talk about the steps we can take to treat it and encourage people to get tested early.”
Yet given his age, perceptions, and reluctance to speak publicly, Arrington says, “it's understandable why people like Secretary Austin might be the ones who will be the hardest to persuade to take that step.”
Ogunsanya is more hopeful: increased attention can help break the culture of silence as well as dismantle homophobic attitudes around testing and detection. She points to R&B star Charlie Wilson -- former lead singer of the GAP Band and a prostate cancer survivor -- as a prominent voice for early detection and treatment.
“We're seeing some men breaking out of that mode,” Ogunsanya says. It’s important, she says, because “being Black is a risk factor” and Austin has a chance to drive the point home when he speaks publicly -- just like Norman Schwarzkopf, a white Army general and architect of the first Gulf War, did when he revealed his diagnosis in 1993.
“I heard lots of (prostate cancer patients) say that they asked their doctors, ‘What did Schwarzkopf do?’” Ogunsanya says. “For a generation of men, he was a masculine archetype. A teachable moment for Austin would be for enough people to know to learn enough about his case so that Black men are using his experiences as a kind of guideline for how they might approach treatment after diagnosis.”
In an ideal world, she says, “Black men would be asking their doctors, ‘What did Austin do?’”
Joseph Williams is The Reckoning’s Race & Health Editor. A seasoned journalist, political analyst and essayist, Williams has been published in a wide range of publications, including The New York Times, The Washington Post, Politico, The Boston Globe, The Atlantic, and US News & World Report.
A California native, Williams is a graduate of the University Of Richmond and a former Nieman Fellow at Harvard University. He lives and works in metro Washington, D.C.