This article first appeared in the St. Louis Beacon, Nov. 15, 2012 - In spite of numerous public education campaigns against breast cancer, black women continue to experience higher death rates from the disease than any other racial or ethnic group, according to a federal report issued Tuesday.
The study, by the Centers for Disease Control and Prevention, said black women were 40 percent more likely to die from breast cancer than white women, and that black women had higher death rates despite having fewer new cases of this form of cancer.
The agency's findings were based on new cases of invasive breast cancer reported between 2005 through 2009. Dr. Thomas R. Frieden, the CDC's director, notes the overall decline in breast cancer death rates in two decades.
“Although we are making progress reducing deaths from breast cancer, we have much work to do to reduce preventable deaths, particularly among African-American women,” he said in a statement. “Only when every woman receives adequate screening, timely follow-up, and high-quality treatment, will the full benefit of breast cancer screening be achieved.”
The report made these key points:
• During 2005–2009, black women had lower incidence rates of breast cancer but higher mortality rates compared with white women.
• Black women had nine more deaths than white women for every 100 breast cancers diagnosed in each group.
• Not all women receive the same follow-up of abnormal screening tests and treatment for breast cancer, leading to disparities in the frequency of breast cancer deaths.
• Black women have higher numbers of advanced stage breast cancer (45 percent) compared with white women (35 percent).
• Patient navigation is a proven intervention in high-risk populations that could decrease inequities in access to timely follow-up and high-quality state-of-the-art treatment for breast cancer.
“I find the deaths unacceptable,” CDC Deputy Director Ileana Arias said at a press conference Tuesday. She said the disparity stemmed in part from an “unacceptable gap in timely, adequate and appropriate health care.”
A second factor, she added, was that the patients have difficulty “navigating the health-care system” to get treatment.
Among those not surprised by the findings but pleased that CDC is giving the issue more attention is Sarah Gehlert, a professor at the Brown School of Social Work at Washington University. She says the cancer death rate for black women in St. Louis was more than 50 percent. That is 10 percent higher than the national average mentioned in the CDC report.
Gehlert is in the second year of a Susan G. Komen-funded study involving 120 women diagnosed with cancer and living in neighborhoods in north St. Louis and north St. Louis County. The goal is to look for factors that help explain the disparity.
“We’re trying to see the way we provide services to African-American women in north city and in the county and how that might contribute to poor outcomes,” she says.
Once they are diagnosed with cancer, too little is being done to break down barriers that discourage some women from getting treatment, Gehlert says. Barriers range from inadequate transportation to being sent to a neighborhood or environment where the patient might not feel comfortable.
“We know that a lot of women quit,” Gehlert says. “They are not able to finish the treatment, and that could contribute to whether they survive. “
While better treatment and early detection are helping to reduce cancer deaths, the report says black women don’t get the same quality treatment as whites. She says, “It has a lot to do with even unconscious biases among health-care providers. Also, we know that African-American women are more likely to live in poverty, and the quality of health-care services for people who live in poverty is much lower.”
One CDC official estimated that the rate of breast cancer deaths among black women would drop by 20 percent if they got the same quality and level of care as white women.
Both Gehlert and CDC officials think the Affordable Care Act might help equalize treatment for all women.
“The Affordable Care Act has the potential to make a difference because for the very first time, it focuses on care needs in the community,” Gehlert says. “We’ve put so many dollars into improving the care in academic centers, but I don’t think we’ve given enough attention to neighborhood clinics where a lot of people get their care.”
