A study showing an alarming gap in breast cancer death rates for black and white women in Chicago has mobilized health experts to find the root causes and recommend within a year ways to reduce the unusually high mortality among African-Americans.
Why black women are more likely to die of breast cancer is unclear, but medical leaders said genetics, lack of awareness about breast self-examination, inability to afford routine mammograms and limited access to medical facilities may play crucial roles.
Another possibility is that some facilities serving black women are doing a poor job of detecting cancers early.
“Women are dying–overwhelmingly poor and black women–because of inadequate quality of the mammography process. That’s our hypothesis,” said Steve Whitman, director of the Sinai Urban Health Institute, which conducted the study released Tuesday.
The study, which has not yet been published or undergone the scrutiny of peers, found that the odds that a woman will die of breast cancer has been declining steadily for close to two decades, yet African-American women have been seeing the reverse. (The report did not analyze data for women of other races.)
As recently as the 1980s, mortality rates for black and white women in Chicago were both around 38 breast cancer deaths per 100,000 women per year, according to the study. The rates started to diverge in the 1990s, as overall mortality rates began to drop thanks to improvements in treatment and early detection.
By 2003, the last year for which statistics are available, the rate for Chicago’s black women was 73 percent higher: 40.5 breast cancer deaths per 100,000, compared to 23.4 for white women.
The study reported the gap in New York City was only 17 percent (35.8 for blacks, 30.7 for whites), which suggests “it’s not just an issue of big urban areas,” Whitman said.
Researchers have been trying for years to discover why black women in America have a higher risk of dying of breast cancer, even though they’re less likely to get the disease.
Some studies have found biological differences that may cause black women to get more aggressive types of breast cancer. Experts say black women are more likely than white women to have a combination of three genetic defects that makes their tumors harder to treat.
Experts also noted that black women also are more likely to get inferior care, fail to seek appropriate testing and be unable to afford routine mammograms.
Sandra Stewart, 55, who lives on the South Side, said she hadn’t had a mammogram in 10 years when she felt a hardness in her breast one morning last October–breast cancer awareness month.
“Most of us can’t afford it,” she said. “I didn’t have any insurance.”
Scared, she called a cancer hot line she’d seen on TV and was able to receive a free mammogram.
“They found an advanced cancer,” she said. “The very same day, they sent me up for a biopsy.”
The Stand Against Cancer project arranged for Medicaid to cover her treatment, and today Stewart is in complete remission.
To address the idea that the mammography available to black women may be of poor quality, the Sinai report calls on area hospitals and breast centers to collect and share mammography quality measures as the first step toward improving services.
