LITTLE ROCK — Black women are dying from breast cancer at a much higher rate than any other racial group. For women over the age of 45, the incidence of breast cancer is more frequently diagnosed in whites. But the percentage of black women surviving breast cancer after five years is 78 percent compared with 90 percent for whites.
There are those who believe that black women tend to have a more aggressive form of breast cancer and are more likely to be diagnosed at a later stage, when the chance of cure is smaller. Studies have shown that genetic differences between blacks and whites may lead to a higher risk of more aggressive tumors in blacks.
However, this notion was questioned at a recent presentation on “The Science of Cancer Health-Care Disparities” at the fifth annual American Association of Cancer Research Conference. In this report, the researchers compared breast cancer outcomes in black, white, Hispanic and Asian women and noted the highest mortality among blacks. However, survival was identical when comparing blacks and whites with similar socioeconomic, reproductive and lifestyle characteristics who were also treated identically.
This information provides more solid support for the well-recognized fact that financial status, lack of access to health care, lack of insurance and perhaps continued discrimination are key factors contributing to a poorer prognosis in black women.
Disparities in outcomes for blacks are not limited to breast cancer. According to the Agency for Health Care Research and Policy, part of the U.S. Department of Health and Human Services, the overall survival of black men and women is significantly lower than whites.
According to the agency report:
For blacks, virtually every illness is diagnosed at a later stage and prognosis is worse.
For heart disease, blacks are 13 percent less likely to undergo coronary angioplasty and 30 percent less likely to have bypass surgery than whites.
In children diagnosed with severe asthma, 7 percent of blacks are admitted to the hospital compared with 21 percent of white children.
Blacks with HIV are less likely to receive adequate retroviral therapy or preventive therapy to prevent serious infections.
In nursing homes, blacks are less likely to have access to glasses and hearing aids, and measures of quality of care are less than for whites.
Leaders within the black community are seriously concerned that there is a widespread distrust of the health-care system among blacks. In an interview in The Washington Post, Dr. Regina Hampton of the Capital Breast Care Center says, “there is a historically unhealthy relationship between African Americans and a medical system that is inaccessible.”
Clearly addressing healthcare disparities must be a central goal of health-care reform. This must include more training on the impact of race, socioeconomic status and education on the risk of illness, and resources must be targeted directly at communities at high risk of contracting and dying from a serious illness.
More health-care providers must be willing, and rewarded, to practice in rural and disadvantaged neighborhoods and there must be a continued commitment to increase the minority healthcare provider work force.
We must also take advantage of the strengths and unique characteristics of ethnic communities. Any approach to increase awareness of screening and illness prevention must be pursued. A good example is the “Witness Program” developed by the University of Arkansas for Medical Sciences at Little Rock. Here, breast cancer survivors return to their communities and witness to other women in their churches about the importance of mammograms and self breast examinations. This has been made easier by mobile mammogram units that travel the state screening as many women as possible.
Hopefully the provision of insurance to those who cannot afford it through the Affordable Care Act will provide better access to care and earlier diagnosis. Most important are stronger public health programs that reach out to the poor and nonwhites through education. There must be a continued and ongoing commitment to rid our nation of scandalous health-care disparities based on race and economic status.
As we move toward refining and improving the healthcare system, nothing is more important than reaching out to those who have inadequate access to care and poor outcomes from many illnesses, including cancer.
Dr. David Lipschitz is co-director of the Healthy Aging Center at Saline Memorial Hospital. More information is available at:
drdavidhealth.com
High Profile, Pages 45 on 11/18/2012