Black men are 50% more likely to develop prostate cancer than white men, according to RESPOND, a 2018 study launched by the National Cancer Institute and the Prostate Cancer Foundation. They also get it at a younger age, and the disease tends to be more advanced when it’s found. What’s more, Black men are twice as likely to die. But why? 

Genetics play a role. But meticulous research by Underwood and others has uncovered a more powerful force: unequal care. In one of his first studies, Underwood found that men diagnosed with the most aggressive form of the disease (and thus most likely to die) were least likely to receive treatment—but only if they were Black. 

He went on to author or coauthor dozens of studies that have revealed racial disparities in the diagnosis and treatment of African Americans with prostate cancer as well as other malignancies. Black men are less likely to be screened and, when diagnosed, less likely to receive treatment. But when they are treated, they respond well. “The problem,” says Underwood, “has not been fixed.”