fall 2004
table of contents
Letter from the Editor
Articles Online

Scandal Patrol
Daughters Helping Working Mothers
Republican Women for Choice
Pregnant Women Murdered
San Francisco Women's Building
Sisters Who Sip


Haitians Fight Despair
Matenwa's Artists
Women with AIDS
Spanish Women in Charge
Gandhi Power
Afghan Women's Vote
Networking Corner

Cover Story
It's the Women, Stupid | Ellen Hawkes
Why the Gender Gap Matters | Eleanor Smeal
Fighting Words for a Secular America | Robin Morgan

More Features

The Unreal World | Jennifer Pozner
Virgin Territory | Camille Hahn
A Family Affair | Gillian Kane
Liv Ullmann: A Ms. Conversation | Robert Emmet Long
Liberating Mary | Bob Lamm


Where's That Smoking Gun? Sex discrimination is getting harder to prove | Pamela Haag

The Breast Cancer Divide: Why the disease kills so many African Americans | Michelle L. Smith, M.D.

A Feast of Feminist Art
"The Dinner Party" finds a home in Brooklyn | Carey Lovelace

Jamesey, Jamesey | Ursula Hegi
Intersection | Roxana Robinson

God Says Yes To Me | Kaylin Haught
| Donna Masini

Touching History
Encounters with women of renown: Marjory Stoneman Douglas, Hillary Clinton and Mamie "Peanut" Johnson

Book Reviews
Bob Bledsoe on The Finishing School by Murial Sparks; Valerie Miner on The Falls by Joyce Carol Oates; Samantha Dunn on The Doctor's Wife by Elizabeth Brundage; Carey Lovelace on Full Bloom: The
Art and Life of Georgia O'Keefe
by Hunter Drohojowska-Philp
; Patricia Cohen on Nightingales: The Extraordinary Upbringing and Curious Life of Miss Florence Nightingale by Gillian Gill

Plus: Fall Must-Read List

Save the Courts | Donna Brazile

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HEALTH | fall 2004

The Breast Cancer Divide
Why are so many African American women dying?

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.”


To learn more about support groups for African American women with breast cancer, visit Breast Cancer Resource Committee; Women of Color: Breast Cancer Survivors Support Project ; and Celebrating Life.

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