HEALTH | fall 2004
The Breast Cancer Divide
When she told her doctors about an amber nipple discharge, 33-year-old Adriene McPhatter was assured she was “too young” to have to worry about it. At her insistence, a mammogram was performed and revealed abnormal calcifications, but those were dismissed as inconsequential.
Nine months later, after seeing another doctor, McPhatter was prescribed a biopsy — which confirmed cancer.
Since the early 1980s, increased mammography screening has led to earlier breast-cancer detection, and mortality rates for American women have declined. Yet African American women, such as McPhatter, have benefited far less from these advances than have white women.
According to a 1999 study reported in Archives of Family Medicine, the chance of dying from breast cancer was 16 percent higher among African American women than white women in 1990 — and that differential rose to 29 percent by 1995.
African American women are less likely than white women to develop breast cancer, but they are less likely to survive it. One reason for those higher mortality rates is that African American women present with higher-grade disease.
A study released in June by the Fred Hutchinson Cancer Research Center in Seattle, Wash., helps explain the disparity: It showed that breast tumors in African American women tend to grow faster and be more aggressive than those of white women, containing abnormal amounts of proteins that control how quickly a cancer cell divides.
Research has also shown that African American women have one-third the chance of white women to have estrogen-receptor-positive tumors. The drug tamoxifen has been found to be beneficial only for such tumors, so African American women are less able to reap the benefit of this promising cancer treatment option.
Tamoxifen notwithstanding, doctors sometimes fail to direct African American women to the most effective treatments, says Zora Kramer Brown, a breast-cancer survivor in Washington, D.C., who founded and chairs the nonprofit Breast Cancer Resource Committee (BCRC).
When African American women do receive equivalent treatment for the same stage of breast cancer, their recovery outcomes are comparable with those of white women. Breast cancer isn’t the only disease that demonstrates a racial differential in survival rates; similar disparities have been reported for other illnesses.
Not surprisingly, income has a lot to do with outcomes: Studies show that it directly correlates with access to preventive health care, utilization rates and medical outcomes. According to reports issued in 2000 by The Kaiser Commission on Medicaid and the Uninsured, nearly 40 percent of the uninsured have no regular source of health care, and uninsured women are over 40 percent more likely to be diagnosed with late-stage breast cancer.
Racial bias and stereotyping have also been implicated in treatment outcomes. Physicians report more negative perceptions of less affluent or lesser-educated patients, and patients from racial and ethnic minority groups report less satisfaction with the care they receive. In short, minorities are simply more likely to receive low-quality health care.
“A lot of times,” says McPhatter, “African American women are pushed to the side.”
On the brighter side, they have now taken it upon themselves to right the inequities. BCRC, which conducts breast cancer awareness programs for minority women and those with poor health-care access, has set a goal by the end of the decade to decrease by 50 percent the incidence and mortality of breast cancer among African American women.
At the federal level, improved breast- and cervical-cancer screening and treatment for minority populations has become a priority.
“The [overall] survival rate is higher now, even though our mortality rate [exceeds that of] white women,” says Brown. “We still have a good chance, long-term, of surviving this disease.”
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