TheLoop21.com

By: Devona Walker (Add to your loop)
Wed, 10/14/2009 - 00:00

Breast cancer victims are the missing voice in the health care debate.

Read more of TheLoop21.com's special series Fighting Black: Breast Cancer in Our Community.

Black women tend to be diagnosed with breast cancer less than white women but when we are, we're more likely to die from the disease. The five-year survival rate for Black women is only 77 percent compared to 90 percent for white women. In the last 20 years, the breast cancer survival rate has improved greatly, but for black women it’s remained stagnant.

The sin of this, is that the disparity could easily be eradicated by universal health care or other significant reform that would cover the millions of Black American women who are disproportionately among the ranks of the uninsured.

Here are the facts, courtesy of the www.BlackWomensHealth.org and the American Cancer Society. 


• Mammograms are the best defense against dying from breast cancer
• Minority women are less likely to receive mammograms than white women
• Breast cancer is the second leading cause of death for Black women
• An estimated 19,540 Black women will be diagnosed with breast cancer this year and more than 6,000 will die in 2009
• The uninsured are more likely to die following a breast cancer diagnosis
• About 21 percent of the black population is uninsured
• Compared with white women, Black women are 53 percent more likely than white women to be diagnosed at a later stage in the disease, about 26 percent less likely to receive radiation after breast-conserving surgery, more than twice as likely to receive no surgery at all and 39 percent more likely to die.

When you look at all the facts, it's not hard to believe breast cancer is more of a threat to Black women than white women. But these factors also show a direct link to our broken healthcare system. They serve as obvious red flags for reform. Yet, in this climate and in this debate, these facts have not been heard.

Inadequate race-appropriate education

Researchers are beginning to realize that breast cancer impacts Black women differently. Socioeconomic and cultural issues that have always been at play, have reduced the survival rate among black women. For instance, because Black women are more likely to be the bread winners in their homes, treatment and recovery becomes complicated due to elevated stress levels. But new research suggest there are also genetic differences as well.

For instance, Black women tend to develop breast cancer earlier in life. Our tumors tend to be harder to detect, more difficult to treat, more aggressive— meaning they multiply quicker. The tumors that affect Black women are also more likely to return.

But much of the mainstream education does not address these differences. For instance, even though the majority of Black women diagnosed with breast cancer are pre-menopausal, the prevailing assumption is that it is a disease  women should be concerned with only after menopause.

A lack of research

Research centered on Black women and breast cancer is very sparse. Fewer Black women are participating in clinical trials, probably because they lack health care insurance. Subsequently, less is known about the biological differences between Black and white women and thousands of Black women continue to die each year.

"There's certainly a lot of interest now to look at the genetics of breast cancer," Northern California Cancer Center Epidemiologist Esther John said. "...We need more research."

In fact, there is one breast cancer strain affecting Black women at a higher rate for which there are no targeted therapies. For most strains, targeted therapies are typically very successful. Just last year, Dr. Eric Winer, director of the breast oncology center at Dana-Farber Cancer Institute in Boston, admitted that he was unsure why this specific subtype was occurring.

“It might be an inherited predisposition or something environmental that Black women are more likely to be exposed to,” Winder said.

Poor communication with women of color

Researchers audiotaped initial consultations between 58 oncologists at 14 practices with 405 women newly diagnosed with breast cancer.

Researchers found that oncologists spent more time building relationships with white patients than with members of other racial/ethnic groups, leading those women— white, younger, wealthier and more highly educated— to ask more questions. Physicians tended to ask them more questions as well. Experts say this lack of interpersonal communication likely contributes to the lower survival rate among Black women.

The deadly silence about the silent killer

The most sinful thing of all, in my opinion, is that despite the thousands of women who die every year, our voices still haven't been heard in the health care reform debate.

Health care reform should be about poor and working class Americans (minorities mostly) who are dying everyday because they can't afford health care insurance for treatment.

So the question remains: where are these voices in the health care debate?

For more resources on breast cancer.

Devona Walker is TheLoop21.com's senior financial/political reporter and blogger. She can be reached at devona@theloop21.com.
 

Have you had enough of the health care reform debate?

Yes, it's not going to happen

Yes, move onto jobs

No, not until it passes

No, it's important

It doesn't affect me

I don't know