Study: breast cancer mortality higher for black women

The breast cancer mortality rate for black women is 68 percent higher than for white women in Chicago, a study by Sinai Urban Health Institute found, and while the reasons for the disparity are complicated, experts said insurance is a major factor.

"Black women are two years behind," said Sharon Brown, supervisor at the Breast Imaging Center at Rush Medical College. "[Doctors] don't catch it early, and it tends to be more aggressive."

For every 100,000 black women nationwide, 34.4 will die of breast cancer. For white women that number is 25.4, according to the organization Y-Me.

In Chicago, in 2003, the last year data was available, for every 100,000 black women, 40.1 died of breast cancer, while 25.9 white women did, the Sinai study said.

"Disparities are related to having insurance or not having insurance," Kristi Allgood, an epidemiologist at the Sinai Urban Health Institute, said this week. "White women are more likely to have insurance that covers beast health, while [many] African-Americans have insurance, but not for breast health."

And those who have some insurance are ineligible for the Illinois Breast and Cervical Cancer Prevention Program, which provides free mammograms, pelvic exams and pap smears to the uninsured.

Gov. Rod Blagojevich expanded the IBCCP program last October by $5 million to $11 million in state dollars, to serve all uninsured women ages 35-64 in Illinois, said Melaney Arnold, spokeswoman for the Illinois Department of Health.

"Parts of the additional $5 million is [for] looking to expand [services] to the underinsured as well," Arnold said.

Until then, if women are on Medicaid, they can get treatment for breast cancer, but it is often difficult to find. It's not profitable for centers to treat people on Medicaid, so spaces are often limited at treatment centers for Medicaid patients, Allgood said.

"There are slots limited where they can go, and after they are diagnosed they have to find someone who will treat them," Allgood said. "It keeps going on and on. It's a huge problem in Chicago."

The quality of mammograms, doctors and care all contribute to the racial disparity in breast cancer mortality.

White women tend to go to private hospitals with better services for mammography and treatment options, while black women tend to use more public hospitals that may be lacking in quality treatment.

"The type of machines that are used, and type of radiologist reading it matters," Teena Francois, another epidemiologist at Sinai, said this week.

The Mammography Quality Standards Act of 1992 mandated image quality, but it doesn't enforce to the same extent who is reading the mammogram.

"It did a good job making sure machines are doing what they are supposed to be doing," Allgood said, "but not far enough in interpreting the image itself."

Transportation is a barrier for some because quality treatment centers are often not located in places where it's easy to get to by public transportation, Francois said.

"A woman may have to take a day off of work, and a couple of buses to get [to the appointment] only to be turned away at the door," Allgood said. "It's a big hassle and she may not come back."

Programs like IBCCP does outreach to get women free screenings.

"We host 'Women Take Charge' nights to try and make sure every woman in Illinois knows this program is available," Arnold said. "We want to provide the best care and treatment."

The program enrolled 8,500 women from last October to February, compared with last year's enrollment of 3,800 during the same time period.

"There are available services, women are just not aware," Brown said.

There is also a distrust of doctors in the African-American community, Allgood said, that dates back to the Tuskegee experiment, where antibiotics were withheld from black people with syphilis that were participating in a study.

"That trickled down through generations, you can't get rid of that so quickly," Allgood said. "People still mention Tuskegee as why they don't trust the health care system."

To lessen the disparity, issues with insurance, access to care, quality of treatment and ability to receive treatment have to be solved, experts agree.

"It's a crazy system," Allgood said. "The system is really basically broken."