Medical experts ask why

Medical experts know black women die of breast cancer at a much higher rate than white women, but they don’t know exactly why.

The reasons are complex and still not fully understood. Most likely black women die at a higher rate for several reasons.

Cancer specialists agree that comparatively less access to insurance, mammograms and treatments are major factors. Most also say that black women are more likely than whites to have a tougher kind of tumor to treat.

A study published this year by the Journal of the National Cancer Institute indicated that black women die of the disease at a higher rate even when they see the same doctors and receive the same treatments.

The American Cancer Society reported that from 2001 to 2005, white women in the United States were somewhat more likely to be diagnosed with breast cancer. But 33.5 black women per 100,000 would die of it, compared to about 24.4 white women, the cancer society reported. Hispanic women died at a much lower rate than either — 15.8 per 100,000.

During that period, 51 black women in Nebraska and 36 in Iowa died of breast cancer, according to state figures.

Mammograms, which are low-dose X-rays of a woman’s breast, are effective screening strategies for breast cancer. Treatments also have improved.

“A death from breast cancer is really tragic in this day and age because the detection is so good,” said Dr. Joann Schaefer, the chief medical officer in Nebraska.

The American Cancer Society generally recommends that women have a yearly mammogram beginning at the age of 40. The cancer society also recommends women in their 20s and 30s have their breasts examined by a health-care professional at least every three years.

“Early detection is really the key to improved survival,” said Dr. Kenneth Cowan, director of the University of Nebraska Medical Center’s Eppley Cancer Center.

Dr. Peter Silberstein, chief of oncology at Creighton University, said there is no doubt that less access to health care plays a role in the higher death rate for black women.

Higher poverty rates among blacks mean less health insurance and reduced medical care, Silberstein said. That also means getting screened for breast cancer less frequently, he said.

Dr. Rubens Pamies, UNMC’s vice chancellor for academic affairs, said education in the broadest sense is crucial to good health. A solid education leads to a good job with insurance and the opportunity to take time off to visit the doctor. It contributes to better living conditions and diets, and safer neighborhoods in which to walk and exercise.

A mediocre job, Pamies said, generally provides less or no insurance, an inability to take time off for doctors’ appointments and access to less medical information.

Georgia Smith, a 53-year-old Omahan, raised four kids and worked two jobs to pay off credit card debt. She said she went four years without getting a mammogram but blames only herself.

Smith had insurance and said she should have been more conscientious about checkups and breast-cancer screening.

“I had no excuse,” said Smith, who was diagnosed with advanced breast cancer five years ago. “It’s just that I wasn’t diligent about it.”

She endured surgery, chemotherapy and radiation treatments. She’s cancer-free now. “I would like to stress the importance of having a mammogram every single year, no matter how much life takes over,” Smith said.

Jackie Hill, a co-founder of the My Sister’s Keeper breast-cancer outreach group, said some women are afraid of going to the doctor for mammograms, and others believe they will be healed by their faith after being diagnosed with breast cancer.

Hill, who is black and survived a bout with breast cancer nine years ago, said she doesn’t know if those notions are more prevalent among black women than white.

She said it’s not completely clear what factors are key to the higher death rates among black women with breast cancer.

“I don’t know the answer,” said Hill, a community nurse coordinator with UNMC’s Center for Reducing Health Disparities. “I don’t think anyone does.”

Experts generally say that black women more frequently than whites have a cancer tumor that is resistant to treatment with chemotherapy and other medications.

A study published in the summer found that black women are more likely to die from breast cancer even if they receive the same care.

The study, overseen by Dr. Kathy Albain, involved 19,457 cancer patients, including 6,676 with breast cancer. Twelve percent of the patients were black.

Albain said through an e-mail interview that it’s indisputable that poor access to care affects cancer survival. But her study leveled the playing field, she said, and still found a worse survival rate for black women with breast cancer.

Albain is a breast and lung cancer specialist at Loyola University Health System in Illinois.

Dr. William Anderson, a cancer specialist and researcher with the National Cancer Institute, said Albain’s findings aren’t consistent with those of some other studies.

One of those he cited, published in the Journal of the National Cancer Institute in 2001, found that black and white women can expect similar results when their breast cancer is diagnosed at a comparable stage and treated appropriately.

Anderson said cancer researchers need to continue pursuing the reasons for worse survival rates among black breast-cancer victims.

“All of us have a bit of the truth. None of us have the whole truth,” Anderson said. “What we’re trying to figure out is what the whole truth is.”

Contact the writer:

444-1123, rick.ruggles@owh.com

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