This article was published in Scientific American’s former blog network and reflects the views of the author, not necessarily those of Scientific American
While the United States has experienced a 27 percent decline in death rates overall over the last 25 years, cancer outcomes continue to be greatly influenced by socioeconomic status and race. Specifically, poor people and people of color have significantly higher cancer mortality rates than average.
A newly released study in the January 2019 issue of the American Cancer Society's CA: A Cancer Journal for Clinicians shows a decline in the mortality gap between blacks and whites, moving from 33 percent in 1993 to 15 percent in 2016. But the findings note that blacks have the highest cancer mortality rate when compared to other racial and ethnic groups.
People living in poverty have lower rates of routine screening and a lower likelihood of getting the best possible treatment. In the U.S., Poverty USA reported that in 2016, Native Americans experienced the highest rate of poverty at 27.6 percent followed by blacks at 26.3 percent and Hispanics at 23.4 percent. For whites, the poverty rate is 12.4 percent, and for Asians 12.3 percent.
Other studies have highlighted the disparities in cancer outcomes for communities of color. A recent study in the journal Cancer Epidemiology, Biomarkers & Preventionshows that black and Hispanic women in Chicago were less likely to be diagnosed at top-tier centers compared to their white counterparts.
In the study of 989 patients over three years, 35 percent of white patients were diagnosed with breast cancer at relatively late stages compared to 47 percent of blacks and 53 percent of Hispanic patients. Researchers attributed the disparity in diagnosis, in part, to the lack of care at high-performing centers of excellence where experts and state-of-the-art diagnostics are available. This finding is particularly important as the stage at cancer diagnosis influences survival.
As a former nurse clinician working in an underserved community on Chicago’s South Side known for its high breast cancer mortality rates, I have experienced the challenge of trying to readily refer women with breast symptoms to any of our leading academic medical centers for care. Uninsured women in particular were more times than not referred to our county hospital, where fewer resources and state of the art diagnostics were available. Even today, zip code and insurance status can influence whether women receive breast cancer care at centers of excellence.
And while breast cancer survival rates have improved over time, the American Cancer Society affirms that disparities exist particularly when comparing white and black women. The relative five-year survival rate is 92 percent for white women and 83 percent for black women.
Black women in particular are more likely to experience more aggressive tumor types and late stage at diagnosis, both of which are contributing factors in cancer outcomes. Also, while treatments have improved over time, in 2015 black women were 35 percent more likely to die from the disease when compared to white women.
I have identified additional barriers for women as young as age 20 in my own studies with African American women. The fear of a potential diagnosis of breast cancer prompted some women to put off being screened or following up once a breast problem was identified.
Young African American women under age 40 have shared with me that providers don’t take them seriously when they present with breast concerns, noting they are too young to have breast cancer.
Today we have a growing number of African American women under age 40 who are being diagnosed with the disease. This is even more disturbing because young African American women tend to present with very aggressive tumor types and need prompt specialized services that will address the comprehensive and unique needs that younger women face.
I know this firsthand as young African American women and their families continue to express frustration with the health care delivery system and the difficulties in getting care at our leading academic medical facilities, especially if they are uninsured or lack adequate insurance coverage.
Cancer advocates have long sounded the alarm, for example noting disparities in cancer outcomes among black women and underserved women residing in the Chicago area. In 2007, the Metropolitan Chicago Breast Cancer Task Force found a 68 percent higher mortality death rate for black women compared to white women. This was in part due to the lack of access to high quality diagnostics and comprehensive services.
Findings helped to shape public policy and inform citywide initiatives aimed at addressing system issues such as access to high quality mammography screening.
As a longtime breast cancer advocate and nurse researcher, I was thrilled to see the focus shift to improving system barriers thought to influence outcomes vs the traditional focus on frequently cited behavioral factors.
Due to the tremendous efforts of the Metropolitan Chicago Breast Cancer Task Force and other partners, since 2017 Chicago has started leading the nation in reducing breast cancer mortality particularly among black women residing in nine urban areas throughout the U.S. Breast cancer mortality is down from 68 percent in 2005 to 39 percent in 2017.
This is not the case for other women residing in other low-income communities throughout the U.S. The fight to improve access to high quality cancer services is far from over just as the fight to ensure access to health care in general is far from over. The two are inextricably linked.
Access to equitable quality cancer services as with any health care service is greatly influenced by socioeconomic status. For example, uninsured adults are more likely than those with insurance to postpone or forego health care altogether. A recent Gallup poll noted that three in 10 Americans forego medical care or defer treatment due to the high cost of medical care.
Key findings from the Kaiser Family Foundation revealed an increase in the number of uninsured in 2017 by approximately 700,000. That is primarily in states without Medicaid expansion. Eleven percent of blacks and 19 percent of Hispanics are at the highest risk for being uninsured, compared to 7 percent of whites.
Many of the uninsured and those without adequate insurance coverage lack access to specialty care providers due to an inability to pay and inadequate reimbursement rates for specialty providers.
Surviving cancer should not be determined by your ethnicity or your income level. But until the gap in access to care is eliminated, that will be the prognosis.