There is a troubling reality about survival rates for women with breast cancer, which is that it varies by race.
Across the United States, an extra 1,710 Black women die of breast cancer each year — approximately five per day — largely due to the difference in access to screening, quality of the screening process, access to treatment, and the quality of treatment. And not only is there a racial disparity in breast cancer deaths, but in many cities, it is a widening one.
Although White women are more likely to be diagnosed with breast cancer, Black women are more likely to die from the disease – troubling findings that have jolted the breast cancer community and spurred many into action.
According to the 2014 study published by Sinai Urban Health Institute and the Avon Foundation for Women, Memphis is the city with the greatest Black:White disparity in breast cancer mortality rates, where the odds for Black women with breast cancer to die are more than double that of White women with breast cancer.
How could this be happening?
Roughly 20 years ago, Black and White women faced about the same mortality risk from breast cancer in most cities. However, since 1990, the death rate among White women has dropped significantly in many cities due to improvements in treatment and prevention technology and medicine, while death rates among Black women dropped only slightly, suggesting Black women were not accessing these technologies.
“Resources are distributed in an inequitable manner. Poor women and women of color have a much less likely chance of accessing high quality care.”
Cities across the country have begun to take action in response to these findings. In Memphis this summer, for example, the public awareness campaign SisterPact kicked off to raise awareness of breast health amongst Black women, including a citywide health fair and other educational programming.
In Chicago, another city with a significant disparity, efforts to increase access to and improve quality of care and treatment have been well underway for years. The Metropolitan Chicago Breast Cancer Task Force was founded in 2008, following research revealing that between 2005 and 2007, Black women in Chicago were dying at a rate 62% higher than White women.
“The [disparity] was startling and utterly unacceptable,” said Dr. Anne Marie Murphy, Ph.D., Executive Director of the Task Force. “The Task Force was set up to address this inequity, and one of our core beliefs is that Chicago’s healthcare system is failing its citizens. Resources are distributed in an inequitable manner. Poor women and women of color have a much less likely chance of accessing high quality care.”
What makes access to and quality of care such a difficult issue to overcome?
Issues preventing women from seeking or accessing care relate to many systemic issues and injustices in the United States. They include a fear of medical institutions, stigma surrounding breast cancer, and a lack of education regarding prevention and survivorship. In addition, women who lack insurance, transportation, and/or childcare support may often place breast health on the backburner. In delaying care, women may lessen their chances of survival by allowing cancer to spread and therefore receive a later stage diagnosis. Although there are also some biological factors that contribute to this disparity, the research makes clear that these barriers to care are the main reasons accounting for the differences.
“There are some mistaken beliefs that if you open or press a cancer it will spread more, or that mammography causes cancer,” said Anne Marie. “Other women think ‘this won’t happen to me because there’s no cancer in my family,’ or conversely, ‘there is breast cancer in my family and there’s nothing I can do about it.’” Anne Marie believes there is definite need for education and raising awareness rather than allowing women to internalize their fears or have misplaced self-blame for cancer.
Anne Marie also cited confusion surrounding U.S. preventative screening guidelines as a factor contributing to Black women not receiving timely care. Current guidelines on when women should get their first mammograms apply for women with an average risk. However, many Black women are at an increased risk of getting breast cancer at an earlier age that is more aggressive and harder to treat, meaning they may not be getting their first mammogram early enough.
How are we making a difference?
To combat these issues in Chicago, the Task Force empowers women through education, community outreach, and a patient navigator program. As women and healthcare providers report the issues they’re facing, the Task Force responds by creating policy and advocacy initiatives to fix the healthcare system to, as Anne Marie puts it, “in essence, change the world here in Illinois.”
This includes assessing the quality of mammography facilities across the city, which can vary greatly. “Unfortunately, but perhaps not surprisingly, the areas with the high death rates either have no facilities or are poor quality facilities,” said Anne Marie “If you are affluent in Chicago, your likelihood of being near a breast imaging center of excellence is approximately 40 percent, but if you are poor, your chance is only 1 percent.”
The Chicago Task Force has also donated high quality machines to neighborhoods with subpar equipment and provided training to radiologists and mammography technicians in low-income areas. Their Beyond October community outreach and navigation program supports uninsured and publicly insured women by offering free, high quality mammograms, and promotes awareness of injustice of these breast cancer outcome disparities. The Task Force also operates a shared clinical nurse navigator program called Extra Help, Extra Care, which is embedded in three lower resourced south side facilities and navigates women with abnormal mammograms onward.
“We do see a better day in the future where the healthcare system in Chicago is more fair, more equitable, and promotes equal chances of survival for all.”
The good news is that the efforts in Chicago appear to be turning the tide. As of October 2014, Chicago has seen the first decrease in the disparity between Black and White mortality rates in close to twenty years, decreasing by 35 percent.
“You can’t just switch disparities on and off, however it’s clear that disparities are not inevitable,” said Anne Marie. “I strongly believe that eliminating breast cancer disparities here in Chicago is doable. We do see a better day in the future where the healthcare system in Chicago is more fair, more equitable and promotes equal chances of survival for all.”
Anne Marie cited other cities, such as New York, Baltimore and San Francisco to demonstrate what’s possible. “There are locations in the U.S. that are racially diverse but do not have breast cancer disparities. There are also locations in the U.S. where successful navigation, outreach and education programs have led to the elimination of disparities.”
For more information, women across the country can utilize the Avon Foundation for Women Breast Health Outreach Program to locate resources in their communities. Similarly, the CDC also provides educational resources and free or low-cost mammograms for women in the United States.
- Journal of Community Health: “Black women’s awareness of breast cancer disparity and perceptions of the causes of disparity.”
Journal of General Internal Medicine: “Fear, Fatalism and Breast Cancer Screening in Low-Income African-American Women: The Role of Clinicians and the Health Care System”