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Cancer Fatalism Among Black South African Prostate Cancer Patients: A Hermeneutic Phenomenological Inquiry at a Tertiary Academic Hospital, Limpopo Province, South Africa

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03 September 2026

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03 September 2026

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Abstract
Cancer fear and fatalism are believed to be associated with lower engagement with cancer prevention participation and/or screening practices among men of African descent worldwide. This is despite black men having a disproportionately higher incidence of prostate cancer (PCa) than any other racial group. The objective of the current study was to explore cancer fatalism among black PCa patients undergoing treatment at a tertiary academic hospital, Limpopo Province, South Africa. A total of twenty (20) black PCa patients, selected through a purposive sampling method, with ages ranging between 67 and 85 years (mean age = 76 yrs; SD = 5.3), participated in the study. The data were collected through in-depth, semi-structured, individual interviews and analysed using Interpretative Phenomenological Analysis (IPA). The results show that cancer fatalistic beliefs are prevalent among the participants in the study. The findings highlight a need to include cancer fatalistic beliefs in any initiatives to improve the uptake of life-saving cancer screening programmes in black communities. Future research may consider longitudinal assessment of fatalistic beliefs and its association with low participation in PCa prevention and/or screening programmes among black men.
Keywords: 
prostate cancer
;  
diagnosis
;  
fatalism
;  
beliefs
;  
self-determination theory
;  
screening
Subject: 
Public Health and Healthcare  -   Other

Introduction

PCa is a major public health burden and one of the leading causes of death among men across the world, particularly in low-medium income countries. Globally, PCa is rated the third most common diagnosed cancer (after breast and lung cancer) [1]. Alarming estimates are that the number of new PCa cases will rise from 1.4 million to 2.9 million by the year 2040 [2]. In South Africa, the setting of this study, black men are disproportionately affected by PCa compared to any other racial group [3,4,5]. Equally concerning is the fact that black South African men frequently present with advanced and a more aggressive PCa at diagnosis [3,6,7]. Delayed diagnosis invariably will lead to poorer health outcomes. Despite this situation, research demonstrates that a significantly small percentage of black South African men (particularly in rural communities) participate in life-saving PCa screening programs [3,7,8].
In most communities, the word cancer is frequently associated with fear because of its association with death. This is despite the fact that most cancers are preventable or can be avoided if appropriate behavioral actions are taken timeously [2,3,9]. With current advances in diagnosis, early detection and prevention programs can arrest cancer progression [10]. Researchers [11,12,13] have long argued that fatalism (the belief that one lacks personal power or control over fate or destiny) is a major barrier to participating in life-saving health behaviors. Fatalism is frequently associated with pessimism and hopelessness [14,15]. If you feel hopeless (and helpless), you may feel powerless and believe you have no control over your situation. Cancer fatalism is a belief about the external causes of cancer, the inability to prevent it, and the inevitability of death when one is diagnosed [16]. It (cancer fatalism) is, therefore, the belief that cancer is uncontrollable and lethal. Cancer fear and fatalism has been identified as a prominent barrier to participation in life-saving cancer pro-screening behavior, early detection efforts, and active participation in treatment programs [13,16,17].
Cancer fatalism is distinguished from cancer fear. According to Vrinten et al. [18], cancer fear is a negative emotional reaction to the threat of cancer whilst cancer fatalism is the belief that a cancer diagnosis is a matter of fate and therefore beyond a person’s control. Put differently, cancer fear refers to an emotional reaction and cancer fatalism refers to the cognitions about cancer (i.e., the belief that the outcome of having cancer is predetermined and unavoidable regardless of personal action).
Taylor's Cognitive Adaptation Theory (CAT) holds that when people are confronted with life-threatening events (like PCa), adjustment depends on their ability to search for meaning in the experience and gain mastery over the event [19]. According to CAT, human beings are adaptable and self-protective in the face of life-threatening events. Cancer fatalism, loosely defined as a belief that cancer is inevitable, uncontrollable, and always fatal, can, therefore, be conceptualised as a defensive cognitive shortcut that arises when the adaptation process relies on extreme external attributions to cope with overwhelming fear [20].
Given the low levels of PCa knowledge and low uptake of screening services among black men in South Africa [4,8], cancer fatalism represents important area health promotion research. The aim of this study was to explore the construct of cancer fatalism. Investigating PCa fatalism among black South African men is, therefore, considered a legitimate variable to explore.

Methods

Study Design

A hermeneutic phenomenological design was used to elicit rich, detailed, first-person accounts of the study participants. The design is rooted in hermeneutics, a method of interpretation and/or understanding of written texts [21]. The design was deemed appropriate because the study aimed to explore participants’ subjective meaning-making of their experiences of PCa diagnosis (i.e., bearing the disease). According to Tavakol and Sandars [22], the purpose of phenomenological qualitative research is to explore everyone’s unique subjective interpretation of an experience. In hermeneutic phenomenological research design, the focus is on understanding the lived experience of study participants, especially how they perceive, experience, and make sense of the phenomenon being studied [22].

Setting

The study was conducted at Pietersburg Provincial Hospital, Limpopo Province, South Africa. The hospital is a tertiary institution where cancer patients from different parts of Limpopo Province receive oncology treatments.

Sampling

The study participants were recruited using purposive sampling. The population comprised twenty (20) elderly black South African men who were diagnosed with PCa and receiving some form of treatment at Pietersburg Provincial hospital. A set of inclusion and exclusion criteria was used for eligibility in the study. The sample size was influenced by both theoretical and practical considerations.

Data Collection

In-depth, individual, semi-structured interviews (conducted in each participant’s preferred language – i.e., Sepedi, Xitsonga, and Tshivenda) were conducted in a private office, ensuring participant confidentiality. A set of open-ended questions (on an interview guide) was used, and each interview took approximately one hour to complete. The interview guide included the following statements: ‘tell me about how the prostate cancer diagnosis affected you?’ and ‘tell me about your experiences with prostate cancer disease’, and ‘tell me about what you think caused the prostate cancer disease?’. The interview guide was first piloted with two black PCa survivors in remission. The first author (a licensed Clinical Psychologist) conducted all interviews and audio-recorded them (with each participant's permission). The interviews ensured sensitivity to each participant's privacy, well-being, and uniqueness. All the interviews transcribed (verbatim) into English. The transcription involved a back-and-forth, structured process of analysis, restructuring, and transfer to ensure that the true meaning is not lost in literal translation. The services of a linguistic expert were used to ensure authenticity.

Data Analysis

Data for the study was analysed using interpretative phenomenological analysis (IPA). Researchers using IPA usually have two main aims, namely, intently listening to the participants expressed accounts of their experience (in order to obtain an insider’s perspective of the phenomenon under study) and attempting to interpret those accounts (in order to gain an understanding of what it means for the participants). IPA is consistent with hermeneutic phenomenological research design [21]. The corresponding author conducted the analysis, as they are experienced in IPA.

Ethical Considerations

Ethical approval for the study was granted by the following bodies: University of Limpopo Turfloop Research Ethics Committee (TREC/26/2015), Limpopo Provincial Department of Health Ethics Committee (Ref:4/2/2), and Pietersburg Provincial Hospital Gatekeeper permission (Ref:2/8/2).

Rigor and Trustworthiness

In ensuring the rigor and trustworthiness of our study, we (authors – all experienced licensed Clinical Psychologists) meticulously cross-checked the data analysis and engaged ourselves in reflective engagements with participants’ narratives and meanings to ensure transferability, credibility, dependability, and conformity. We acknowledged and clarified potential biases during data analysis.

Results

The study comprised twenty participants (n=20). All were diagnosed PCa patients (> 5 years) receiving some form of treatment at the Pietersburg Tertiary Hospital urology clinic. Their ages were between 67 and 85 years of age (meanage = 76 years; SD= 5.3). The majority (n=12) were widowed, retired (n =16), and on a government social security grant (14). Almost all (n=19) had no family history of cancer and none (n=20) had previous screening for PCa.
The table below (Table 1) highlights a summary of the demographic profile of the participants (n=20).
Table 2. Quotes highlighting cancer fatalism.
Table 2. Quotes highlighting cancer fatalism.
Participant ID Narrative Quotes


D
“Then I go home, and they tell me this illness you are having. It …it is dangerous. They say it kills. Someone says many people died, and even the hospital doesn’t know how to treat it. I just listen. Then I was very scared …and I did not tell anyone. My daughter just said I will be fine. When I came here to see the doctor. I asked the doctor. The disease is going to kill me then he says no. He said he would help me. I just say ok. Even when I was sleeping, I was thinking about this illness.”

G
 “I did not know about his disease. I have heard that there is a disease called cancer, but I did not know what it is. People say the cancer can kill you if you get it. They say that even doctors can’t cure it. About this one that the doctor says I have, I did not know it before I came here. Many people do not know it.”

K

 “I did not know this disease before my diagnosis. I didn't even know a disease like this existed. I remember though that my brother was having a disease that looked like what I was going through. He died, but no one knew what killed him. Now I think it could have been this disease.”

L
“I did not know anything about this disease. The doctor said he has seen many men with this disease, but it was the first time for me to hear about it. I once went to a funeral, and the people there were saying that she died of cancer that was on her breast. This is the only thing I know. They said at the funeral of the dead lady that cancer can kill you fast.”

O
“I did not know what to say. It was like life was upside down. It was bad. I could not think clearly. I was almost about to cry. It was very bad, and I was scared for my life. I was thinking, I am going to die. I did not have any future anymore. My life was finished”.


S
“It was shattering when the doctor mentioned that I had cancer. I began to worry about how long I was going to live. You see, I have heard that this illness, cancer, would kill you. They say even the doctors cannot heal you. You just get sick and sick and sick until you die. This made me feel hopeless, but I did not know what to do. I looked at myself and said...I am just waiting to die from this cancer. I did not know, and I was unable to think of anything. The only thing I could think of was the cancer. My life was changed, and I can’t do anything about that.”

Discussion

The aim of the study was to explore cancer fatalism among black South African men diagnosed with PCa. According to Lyratzopoulos et al. [23], fatalism (including cancer fatalism) is often conceptualised (inaccurately) as encompassing elements of ignorance and irrationality. The authors contend that the focus of most cancer fatalism research has been to understand the reasons why people do not follow the presumably “rational” recommendation of being pro-health in their mindset. Keller et al. [13] concur and further argue that although there is an abundance of research on cancer fatalism, the concept (cancer fatalism) remains poorly understood. Another complicating factor is that most studies on cancer fatalism are biased towards historical, under-resourced populations [20,24]. Other factors that influence health behavior and outcomes, such as culture, lack of access to health services, substandard medical care, competing priorities, and inadequate knowledge, are frequently ignored. For example, culture has been recognized as an important factor that influence people’s health beliefs, including health-related behavior [14]. The authors contents that cancer fatalism is not an irrational thought [13]. A major concern with this mindset is its consistent focus on the “other” [20]. Thus, it is not surprising that most research on cancer fatalism has involved traditionally underserved communities who are frequently labelled “irrational”.
None of the participants knew about PCa before their diagnosis (poor knowledge). None of the participants had participated in any PCa screening before their diagnosis. In their majority, the participants showed (narrated) high levels of cancer fear and cancer fatalistic beliefs. The significant levels of PCa fatalism among the participants in the study may be a reflection of a diminished sense of personal control over their health outcomes. This suggests that participants felt they had limited control over their fate regarding their condition (PCa) or survival. They viewed or equated their PCa disease as death sentence. This is in line with what has been found in other studies [9,13,18,20]. People with high cancer fatalistic beliefs will exhibit reduced motivation for screening and/or prevention behaviors, contributing to poorer health outcomes [20]. Previous research [9,11,12,13,24] has shown that cancer fatalism can impede proactive health behaviors.
The CAT framework provides a vital lens for examining cancer fatalism in this study. The CAT posits that when people have lower levels of personal control over highly stressful life events, they adapt poorly and experience maladjustment [20]. According to Chen and Kim [25], cancer fatalism is a cognitive construct with multiple dimensions. Accordingly, when individuals are faced with a life-threatening event (e.g., prostate cancer), they desperately try to restore balance by searching for meaning in the experience. This may include trying to understand why the illness happened in the first place, frequently followed by desperate efforts to exert mastery over the disease. When a person feels wholly incapable of gaining mastery (control) over the disease (prostate cancer), they may shift to external control (e.g., fate, destiny, God, etc.). Put differently, when self-efficacy (mastery over PCa) fails, fatalistic beliefs function as a psychological buffer. This is achieved by accepting a predetermined outcome (e.g., an external higher power), leading to the conclusion that human (personal) actions cannot change the outcome. According to Liu and Jia. [9]), religious and certain cultural beliefs shape this kind of predestined view (i.e., beyond human control). It is, therefore, highly likely that an overall fatalistic outlook on life may also influence cancer fatalistic beliefs in people. Kim and Lwin [14] put it succinctly thus: “Individuals make sense of their life events, including cancer-related experiences, through their own cultural worldview” (pp. 1201). Cancer fatalism is characterised a perceived lack of control over one’s health, the attribution of cancer to predestination, fate, destiny, and powerlessness and hopelessness caused by the inevitability of death [25]. The prevailing explanation is that cancer fatalism fosters passive resignation, deeming personal health efforts as futile or unnecessary [20]. Several studies [9,11,12,13,20,26] have shown cancer fatalism negatively influences cancer screening uptake and participation.
Keller et al. [13] contend that cancer fatalism is associated with negative health outcomes, including non-participation is screening initiatives, late presentation to healthcare providers for timely diagnosis, and suboptimal adherence to treatment regimens. Given its culpability in uptake of PCa screening, cancer fatalism represents an important factor of health promotion research. Shifting cognitive perceptions of PCa controllability among black South African men may represent a crucial approach to improving pro-screening attitudes. Effective positive health persuasion should be grounded in the epistemic belief that cancer can be controlled through personal action. The findings support incorporating information about the curability of PCa (i.e., early stages) into public education and/or awareness campaigns.

Conclusions

Cancer fatalism is prevalent among black South African men. Cancer fatalism is a cognitive construct with multiple dimensions to it. These dimensions may include religious and cultural attributes. PCa fatalistic beliefs may be a factor in the poor uptake of life-saving screening participation among black South African men. This may be an important observation in the context of behavior change. Therefore, addressing PCa fatalism may promote screening participation.

Limitations of the Study

The current study has limitations. Firstly, the sample comprised elderly black men who were already diagnosed with PCa and receiving some form of treatment. Secondly, the participants reflect the population of specific ethic groups and geographic areas of South Africa. This limits the generalisation of the findings. Nevertheless, this study makes a significant contribution to PCa research among black men in South Africa.

Author Contributions

SN was the principal investigator. He conceptualised the project and contributed to the overall design, management, and manuscript writing. TS provided insights into data analysis and guided the manuscript write-up. KT contributed to data analysis and critical review of the draft.
Data availability: Due to the ethical nature of the study (which excluded data sharing), the data used in the study are available on request from the corresponding author.

Funding

The study received funding from the National Institute for Humanities and Social Sciences (NIHSS/SAHUDA/UL/14).

Institutional Review Board Statement

Ethical approval and clearance for the study were obtained from the University of Limpopo Turfloop Research Ethics Committee (TREC/26/2015: PG, Date 06 May 2015). Further permission was obtained from the Limpopo Provincial Department of Health (Ref4/2/2, Date 15 June 2015) as well as gatekeeper permission from Pietersburg Provincial hospital (Ref2/8/2, Date May 2015).

Acknowledgments

All authors (SN, TS, and KT) express sincere acknowledgment to all the study participants for sharing their personal information.

Conflicts of Interest

The authors declare no conflict of interest relating to the study.

References

  1. Zhao, X.; Liu, S.; Zou, Z.; Liang. Global, regional, and national prevalence of prostate cancer from 1990 to 2021: a trend and health inequality analyses. Front. Public Health 2025, 13, 1595159. [Google Scholar] [CrossRef] [PubMed]
  2. James, N.D.; Tannock, I.; N’Dow, J.; Feng, F.; Gillessen, S.; Ali, S.A.; Trujillo, B.; Al-Lazikani, B.; Attard, G.; Bray, F.; et al. The Lancet Commission on prostate cancer: Planning for the surge in cases. Lancet Google Scholar] [CrossRef] [PubMed]. 2024, 403, 1683–1722. [Google Scholar] [CrossRef] [PubMed]
  3. Benedict, M.O.A.; Steinberg, W.J.; Classen, F.M.; Mofolo, N. The profile of Black South men diagnosed with prostate cancer in the Free State, South Africa. S. Afr.Fam.Pract. CrossRef. 2023, 65, el–e10. [Google Scholar] [CrossRef] [PubMed]
  4. Dewar, M.J. Investigating Racial Differences in Clinical and Pathological Features of Prostate Cancer in South African Men. Unpublished Master’s Thesis, Division of Urology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, 2016. Available online: http://hdl.handle.net/11427/22753 (accessed on 7 July 2026).
  5. Komane, B.M.; Mosalo, A. Experiences of men undergoing prostate cancer screening at a hospital in Gauteng, South Africa’. Health SA Gesondheid 2024, 29(0), a2698. [Google Scholar] [CrossRef]
  6. Tindall, E.A.; Monare, L.R.; Petersen, C.C.; Van Zyl, S.; Hardie, R.; Segone, A.M.; Venter, P.A.; Bornman, R.; Hayes, V.M. Clinical presentation of prostate cancer in black South Africans. Prostate Google Scholar] [CrossRef. 2014, 14, 880–891. [Google Scholar] [CrossRef] [PubMed]
  7. John, J.; Adam, A.; Kaestner, L.; Spies, P.; Mutambirwa, S.; Lazarus, J. The South African Prostate Cancer Screening Guidelines. S. Afr. Med. J. Google Scholar] [CrossRef. 2024, 114, e2194. [Google Scholar] [CrossRef] [PubMed]
  8. Nkoana, S.; Sodi, T.; Themane, M. Prostate cancer knowledge, beliefs and screening uptake among black survivors: A qualitative exploration at a tertiary hospital, Limpopo Province, South Africa. Int. J. Environ. Res. Public Health 2004, 21, 1212. [Google Scholar] [CrossRef] [PubMed]
  9. Liu, Q.; Jia, H. How supernatural and scientific beliefs influence individual cancer prevention behaviors: an empirical study of young Chinese adults. Front. Public Health 2025, 13, 1711669. [Google Scholar] [CrossRef] [PubMed]
  10. Kim, H. K.; Lwin, M. O. Cultural Effects on Cancer Prevention Behaviors: Fatalistic Cancer Beliefs and Risk Optimism Among Asians in Singapore’. Health Commun. 2017, 32(10), 1201–1209. [Google Scholar] [CrossRef] [PubMed]
  11. Zaidi, M.; Sarkar, S.; Arakelyan, S.; Poghosyan, H. Relationship Between Fatalistic Cancer Beliefs and Risky Health Behaviors. West J. Nurs. Res. Epub. 2024, 46(10), 757–765. [Google Scholar] [CrossRef] [PubMed]
  12. Paige, S.R.; Alpert, J.M.; Bylund, C.L. Fatalistic Cancer Beliefs Across Generations and Geographic Classifications: Examining the Role of Health Information Seeking Challenges and Confidence. J. Cancer Educ. 2021, 36(1), 3–9. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  13. Keller, K.G.; Toriola, A.T.; Schneider, J.K. The relationship between cancer fatalism and education. Cancer Causes Control 2021, 32(2), 109–118. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  14. Kim, H. K.; Lwin, M. O. Cultural Effects on Cancer Prevention Behaviors: Fatalistic Cancer Beliefs and Risk Optimism Among Asians in Singapore. Health Commun. 2027, 32(10), 1201–1209. [Google Scholar] [CrossRef] [PubMed]
  15. Lee, C.J.; Niederdeppe, J.; Freres, D. Socioeconomic Disparities in Fatalistic Beliefs About Cancer Prevention and the Internet. J. Commun. 2012, 62(6), 972–990. [Google Scholar] [CrossRef] [PubMed]
  16. Kaur, L.; Sharma, S.; Kaur, A. Fatalism and Stigma Amongst Cancer Patients in South Western Punjab. ECJ 2021, 22, 375–386. [Google Scholar] [CrossRef]
  17. Zhang, L.; Jiang, S. Examining the Role of Information Behavior in Linking Cancer Risk Perception and Cancer Worry to Cancer Fatalism in China: Cross-Sectional Survey Study. J. Med. Internet Res. 2024, 26, e49383. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  18. Vrinten, C.; Wardle, J.; Marlow, L.A. Cancer fear and fatalism among ethnic minority women in the United Kingdom. Br. J. Cancer 2016, 114(5), 597–604. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  19. Czajkowska, Z. Theory of Cognitive Adaptation. In Encyclopaedia of Personality and Individual Differences; Zeigler-Hill, V., Shackelford, T., Eds.; Springer: Cham, 2017. [Google Scholar] [CrossRef]
  20. Tsai, W.; Wang, J.H. Fatalism and Psychological Distress Among Chinese American Breast Cancer Survivors: Mediating Role of Perceived Self-control and Fear of Cancer Recurrence. Int. J. Behav. Med. 2023, 30(5), 705–713. [Google Scholar] [CrossRef] [PubMed]
  21. Oether, S. Analysis methods in hermeneutic phenomenological research: interpretative profiles. Front Nurs. 2020, 4, 293–298. [Google Scholar] [CrossRef]
  22. Tavakol, M.; Sandars, J. ‘Twelve tips for using phenomenology as a qualitative research approach in health professions education’. Med. Teach. 2025, 47(9), 1441–1446. [Google Scholar] [CrossRef] [PubMed]
  23. Lyratzopoulos, G.; Liu, M.P.; Abel, G.A.; Wardle, J.; Keating, N.L. The Association between Fatalistic Beliefs and Late Stage at Diagnosis of Lung and Colorectal Cancer. Cancer Epidemiol. Biomark. Prev. 2015, 24(4), 720–6. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  24. Lopez Torralba, L.; Sukhu, B.; de Azevedo Daruge, M.E.; Chung, J.; Loerzel, V.; Lee, E. Evaluating Fatalism Among Breast Cancer Survivors in a Heterogeneous Hispanic Population: A Cross-Sectional Study. Curr. Oncol. 2025, 32(8), 461. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  25. Chen, M.; Kim, H. K. Cancer Fatalism in the Information Age: A Meta-Analysis of Communicative and Behavioral Correlates. Commun. Res. 2024, 51(1), 83–111. [Google Scholar] [CrossRef]
  26. Uncu, F.; Evcimen, H.; Çiftci, N.; Yıldız, M. Relationship between health literacy, health fatalism and attitudes towards cancer screenings: latent profile analysis. BMC Public Health 2025, 25(1), 2056. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
Table 1. Demographic Profile of Participants (n =20).
Table 1. Demographic Profile of Participants (n =20).
Participant ID Age Race (Ethnicity) Marital status Occupation Education level Previous screening
A 78 Black (Tsonga) Widowed Pensioner Primary None
B 85 Black (Venda) Widowed Pensioner Primary None
C 68 Black (Pedi) Married Retired Tertiary None
D 77 Black (Pedi) Widowed Pensioner Secondary None
E 76 Black (Venda) Widowed Pensioner Secondary None
F 80 Black (Venda) Married Pensioner Secondary None
G 83 Black (Pedi) Widowed Pensioner Secondary None
H 67 Black (Pedi) Married Retired Tertiary None
I 70 Black (Tsonga) Widowed Retired Tertiary None
J 83 Black (Pedi) Married Pensioner Secondary None
K 75 Black (Tsonga) Widowed Pensioner Secondary None
L 82 Black (Pedi) Widowed Pensioner Tertiary None
M 73 Black (Tsonga) Married Retired Tertiary None
N 74 Black (Pedi) Married Retired Tertiary None
O 77 Black (Venda) Widowed Pensioner Secondary None
P 80 Black (Tsonga) Widowed Pensioner Primary None
Q 75 Black (Venda) Widowed Pensioner Primary None
R 69 Black (Pedi) Married Retired Tertiary None
S 71 Black (Tsonga) Married Retired Secondary None
T 81 Black (Pedi) Widowed Pensioner Primary None
Notes: Previous screening refers to any history of PCa screening participation.
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