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VOL. 6 • NO. 2
© October 2011
African Americans are suffering from cancer at far greater rates, but the numbers are improving ever so slightly. Researchers say early screenings are part of the reason. Talk about a cultural change. Hawo Adan-Abdi, 51, readily admitted she was not excited about the prospect of regular breast cancer screenings. But the providers at Whittier Street Health Center (WSHC) persisted and when she saw that women emerged from the test unscathed she eventually relented. Adan-Abdi is not alone. Many women share her fears. WSHC personnel found that out firsthand when they conducted focus groups with Somali women to understand their perceptions of the test and the disease. It was an eye-opener. The participants likened the mammogram to a “pancake machine that squeezes your breast.” While all understood its purpose, all commented on its discomfort. “When I hear mammogram I am in pain” was one response. But Adan-Abdi is not complaining. The discomfort of mammograms pales in comparison to fleeing war-torn Mogadishu and the perils of living in a refugee camp with five of her children. There was no such thing as yearly physicals in her native country, much less cancer screenings. “Back home you go to the hospital only if something is wrong,” she explained. And that’s the point of screenings — to detect “something” early enough to increase the odds of survivability. But the reality is pretty grim when it comes to cancer and its impact on African Americans. Blacks have the highest death rate and shortest survival of any racial and ethnic group for most cancers. Nearly 169,000 new cases of cancer are expected in African Americans in 2011 — and roughly 65,500 deaths — according to the American Cancer Society (ACS). It sounds bleak but when one considers the starting point, progress has been made. Since the early 1990s, the incidence rate of most cancers has decreased or stabilized. Death rates have declined as well — by 2.5 percent a year in men and 1.5 percent a year in women. Particularly notable is lung cancer, according to the ACS, where rates of death have decreased faster in African American men than white men. This improvement is significant given the fact that lung cancer is the leading cause of cancer deaths. Despite these improvements, the gap persists between blacks and whites in cancer cases and deaths. Black men have the highest
Cancer, the second leading cause of death in this country, is the uncontrolled growth and spread of abnormal cells. The American Cancer Society estimates 1,596,670 new cases of cancer in 2011 and almost 572,000 deaths. Cancer strikes all races and ethnicities, but African Americans — particularly black males — are disproportionately impacted.
death rates of any group, most notably in prostate cancer where black men die at two to five times the rate of all other races. Black women, on the other hand, pose a different, and often puzzling, picture. While the incidence of cancer overall is highest among white women, blacks have a higher death rate. For instance, while white women are diagnosed more frequently with breast and uterine cancer, the first and fourth most common cancers in women, blacks die of both more often. What researchers have found more troubling is that those rates occur even though black women are regularly screened, and at a rate higher than white women, especially here in Massachusetts. According to the 2010 Behavioral Risk Factor Surveillance System (BRFSS), a survey developed by the Centers for Disease Control and Prevention, more than 94 percent of black females
A disturbing difference Although death rates from cancer are on the decline, the disparity between blacks and whites persists. Between 2003 and 2007, the death rate in blacks was 23 percent higher than whites and more than double the rate in Asians. Black
224.2
White
182.4
Native American
156.7
Hispanic
122.1
Asian
110.8
0
50
100
150
200
Death rates are per 100,000 and age-adjusted to the 2000 U.S. standard population Source: National Center for Health Statistics
250
aged 50 or older in Massachusetts reported that they had received a mammogram within the past two years. This percentage exceeded that of all other women in the state — and in the country, for that matter. Pap smears show similar results. More than 93 percent of black women in Massachusetts — compared to 86 percent nationwide — said they had received the test within the past three years. The numbers begin to recede in regards to colorectal cancer screening, but still are higher than expected. Almost three-fourths of black adults aged 50 or older interviewed in the state said they had received a sigmoidoscopy or colonoscopy. White adults exceeded this number by only 4 percent. Prostate cancer screening is a totally different story altogether — for all races. The BRFSS reports that only 54 Adan-Abdi, continued to page 4
Increasing access key to closing the gap Dr. Christopher Lathan, a thoracic oncologist at Dana-Farber Cancer Institute, has his work cut out for him. As director of the Cancer Care Equity Program at the Institute, his goal is to make sure that minorities have access to and receive the quality of care they need to combat their disease. And that’s not easy. There have been some improvements over the years. “The mortality rates for cancer have decreased overall,” he said. “But the difference between the races remains the same.” And the disparities start from the first step in fighting the disease — screenings. Nationwide minorities are less likely to receive recommended screenings for many reasons. Lack of insurance and transportation and loss of income when away from work are all factors. But it’s that next step that concerns Lathan even more. It’s a challenge to get people to follow up after a positive finding on a screening test. This is often the time when people run scared. Also, other commitments like family or a job might take precedence. More often than not, it’s easier to postpone
treatment when you’re feeling fine. “It means another day off from work,” Lathan explained. Some people might think: “Why should I take a day off work and pay another co-pay when they’re going to tell me something I don’t want to hear?” A recent study published in the Journal of the National Cancer Institute bore that out. Of those referred for additional testing following an abnormal sigmoidoscopy, a screening tool for colon cancer, only 62 percent of blacks compared to 72 percent of whites followed up for additional testing. Lathan places some of the blame on the medical profession. “It’s up to the doctor to make a clear path,” he explained. “The key is to know your community. Then make the system easier by putting in structure [for follow-up]. Have someone call and tell the patient where to go next.” After an initial screening, the next step can be confusing. While the protocol for breast cancer is well devised, it is not as clear cut with other types of cancer, Lathan said. The patient may require another
Lathan, continued to page