Cancer deaths down overall, but still high in disadvantaged communities

Death rates from cancer have declined by 20 percent over the last two decades, according to the Cancer Statistics 2014 released in early January by the American Cancer Society.

But despite the decreasing numbers overall, the report pointed out the recurring correlation between low socioeconomic status and survival rates, saying that it is the likely explanation of how late in stage a cancer is detected and is associated with different types of treatments among blacks.

“People with lower socioeconomic status have double the cancer death rate of affluent people,” said Rebecca Siegel, co-author of the Cancer Statistics 2014.

The findings show the disparities despite the overall decline in past years:

• From 2003 to 2009, the survival rate for white patients with breast cancer was 92 percent compared with 79 percent of black women

• From 2006 to 2010, the incidence and death rates of prostate cancer for white men was 138.6 and 21.3, respectively, compared with 220 and 50.9 of black men, respectively (per 100,000 population)

Many studies have been done defining the relationship between level of socioeconomic status and mortality rates. Bijou Hunt, an epidemiologist at Sinai Urban Health Institute, was part of a study involving the 77 community areas in Chicago. Factors of population, such as those on welfare, under the poverty line and those who are unemployed, were calculated and the results show a relatively strong connection between low socioeconomic status and mortality rates, Hunt said.

She said that a lot of her work has concentrated on the notion that racism and segregation in Chicago – and the U.S. overall – have contributed to this disparity in health.

“People who are of lower [socioeconomic status] do not have the quality (of health care) like their richer counterparts,” Hunt said. “They wind up going to lower-quality facilities and receiving lower-quality care.”

In 1990, Dr. Harold P. Freeman, who focused his research on treatment based off race – specifically black men in Harlem – founded a patient navigation program to increase access to health care. The two-day program trains and prepares individuals to spread awareness while being culturally sensitive to those in dealing with cancer.

Monique Mitts has been a patient navigator at Sinai since 2007, working with low-income breast cancer patients who show an initial abnormality in their mammograms. She follows up with patients, schedules appointments and relays doctors’ orders, relieving some of the responsibilities for the patients. And when a patient doesn’t show up, Mitts tries to track them down to ensure they get the proper treatment.

“They’re not really understanding the importance of having their mammograms,” she said. “Once you tell them it’s abnormal, it’s really easy to lose them.”

Mitts said one of the biggest problems is that most of the patients poorly educated on health issues. Patients hear stories from friends or family and believe what they hear before asking for a professional opinion. The misconceptions they have prevent early detection and delay treatment.

“People have told them you can catch cancer from having mammograms,” she said. “They say it hurts. I tell the woman having the mammogram that…it’s just as bad as braiding your hair tight.”

Outreach programs in low-income communities are leading us in the right direction, agrees Dr. Tomi Akinyemiju, an epidemiologist at Columbia University.

“We can’t use the excuse that people just refuse or people don’t understand, especially after we cure the access (issue),” she said. “We need to make an effort to be culturally aware.”

Her research focuses on breast cancer survival disparities between black and white women. Though she said genetics do contribute some, more attention needs to be focused on socioeconomic status and health care resources.

Akinyemiju said the Affordable Care Act has increased access to screenings and early treatment since its implementation, but because it is still new, it will be awhile before we can see any long-term effects in closing the gap in death rate disparity.

“We have trained doctors, medication being developed,” she said. “We have no excuse why everybody shouldn’t be getting the best attention.”

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