Ebony, ivory and breast cancer disparity

African-American women die from breast cancer more often than Caucasian women, and clinicians at the Northwell Health Cancer Institute are working to find out why.

“We’re trying to figure out where the gaps are and how to address them,” said Janna Andrews, MD, a radiation oncologist at the Cancer Institute.

Despite similar rates of mammography use in the US, black women die from breast cancer at a 10 percent higher rate than white women, according to the Susan G. Komen Foundation. Other studies reveal similar rates of diagnosis, but the diagnoses come at a more advanced stage for black women.

“Some research findings demonstrate that African American women have more delays in follow-up care after an abnormal mammogram than white women,” Dr. Andrews said. “Those delays likely play a pivotal role in the lower survival rates.”

Implicit bias, lack of access to care and cultural nuances influence those delays, she added. “It’s no longer acceptable to assume a patient was diagnosed later because they were in denial or afraid to have a mammogram,” Dr. Andrews said. “We have to take a look at the role implicit bias plays among physicians and why there are such disparities.”

Many challenges

Education and socio-economic standing affect follow-up care for mammograms for all races, Dr. Andrews said. Other factors contribute to higher mortality rates. One of the most prominent — access to care — can be hard to quantify.

“Many things limit access to care,” said Dr. Andrews. “Transportation is often an issue: ‘Do I need a car?’ Does public transportation make it easy or more difficult? In addition, some patients can’t afford to take time off work or have child-care concerns. These issues all qualify as lack of access, but they are not easily tracked.”

Health literacy is a common challenge, but is an even greater barrier for patients with limited English fluency. “Physicians must take the time to ensure that patients understand what is being communicated about their health,” Dr. Andrews said. “Frankly, many times this is often one of the more significant challenges.”

Many providers are expressing concern that the new political climate will build new barriers to care. Undocumented residents can worry that a screening may reveal their immigration status and trigger deportation. And regardless of background, patients sometimes avoid doctor visits because they fear a diagnosis.

“When people put off care, they come to us sicker and in need of more services. That puts additional costs and stress on the health care field,” Dr. Andrews said.

Not-too-distant memories of discriminatory practices elicit reluctance among some African Americans. Some community members still feel mistrust, according to Dr. Andrews. Northwell Health is working to reverse those perceptions through outreach events like screenings and health talks, with followup care whenever necessary.

“We are looking at ways to provide better screening and care by making sure individuals follow through on subsequent appointments,” Dr. Andrews said. She added that previously, patients who didn’t follow up on care just had “noshow” or “noncompliant” noted in their file. “Now we ask why they didn’t show, reaching out to see how we can help make sure that they do.”

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Featured in the following publications:

The New Standard 2017