WASHINGTON -- Regardless of insurance status, black women are about two times more likely than white women to be diagnosed with late stages of breast cancer, according to statistics released Friday by the American Cancer Society (ACS).
For Thelma Jones, this racial disparity resonates deeply. An African-American women from North Carolina, Jones delayed screening for several months before she was diagnosed with breast cancer in June of 2007.
“When I discovered a lump, I was busy doing everything but what I should have been doing: focusing on my health,” she said. “But the longer you wait, the less likely you are to survive, and the more costly treatment becomes.”
In recent years there have been notable advances in cancer prevention, screening and treatment, but uninsured and minority populations are still not benefitting equally from such progress.
As President Barack Obama pushes to finalize health care reform, a panel of cancer survivors and advocates met with journalists, students and medical professionals Friday to highlight these health care disparities. Organized by the National Association of Black Journalists, the discussion was part of a three-day conference on health policies for underserved communities.
“If you’re uninsured, you are 50 percent more likely to die of cancer, and if you’re black, the chances are greater,” said Linda Blount, national vice president of the ACS health disparities office. “You don’t want to be poor in this country, but you really don’t want to be poor and black.”
Cancer mortality rates have been declining about two percent annually since the late 1990s, but minority, low-income, uninsured and Medicaid patients are less likely to be diagnosed early—lowering their odds of survival.
For example, the difference in colonoscopy screening rates among racial groups was 21 percent in 2005, compared to 12 percent in 1998, according to ACS research. Uninsured and Medicaid patients are more than two times likely to be diagnosed with late stage breast cancer than privately insured persons.
Minority and low-income patients are also less likely to receive recommended treatments like chemotherapy and breast conserving surgery. African-Americans are 50 percent less likely to receive appropriate treatments for breast cancer, and American Indians are 70 percent less likely, according to ACS statistics.
As a result, minorities and low-income cancer patients face higher mortality rates. ACS statistics show that African-American men are 50 percent more likely than white men to be diagnosed with prostate cancer, and 200 percent more likely to die from it. While white women are more likely to be diagnosed with breast cancer, the morality rates are 30 percent higher for African-American women.
The underlying causes of these differences span social, behavioral and economic realms.
Minority and low-income patients face structural barriers to care, including financial costs, lack of transportation, low health literacy or lack of provider referral. Cultural barriers like poor doctor-patient communication and language differences also aggravate cancer care disparities.
“I have retirement savings, the ability to read and write, and the time to challenge my insurance company,” said Jones, who survived her cancer but dug deeply into personal and family savings in order to do it. “But when you’re a minority and you’re working, and when you have language barriers, the fight is even more difficult.”
Experts at the conference believe health care reform can help close the gap.
“The best way to ensure improvements is to increase access to care,” said Stephen Finan, the senior director of policy for the ACS Cancer Action Network. “Federal insurance subsidies would disproportionately help many minorities, and Medicaid could become available to more people.
Members of the panel said it is important to increased funding for early cancer detection programs. The National Breast and Cervical Care early Detection Program targets low-income, uninsured women, but the program can only serve 20 percent of eligible women due to funding constraints.
Patient navigation programs can also help patients in underserved communities seek cancer screenings and follow up exams, while health insurance assistance services can help them pay for treatment.
Cancer treatment advocates at the conference hope these efforts will reduce racial disparities by improving access to care.
“There’s nothing inherent about people of color that makes them more likely to get cancer,” said Blount. “It’s not about race. It’s about the effects of race.”