Twice As Deadly: Researchers Look to Mammograms to Help Explain Race Gap in Cancer Deaths
Picture two lines on a graph – one represents the death rate of white breast cancer patients, the other of black patients. Starting in 1980 the lines follow pretty much the same path. Ronald Reagan came and went, the U.S. liberated Kuwait, the internet blossomed, and still. The black and white death rates in Chicago were more or less the same.
Then, starting in the mid-'90s, the lines on that graph diverged. White women started doing much better – their death rate plunged. For black women, the rate didn't change. Steven Whitman of the Sinai Urban Health Institute says that split coincided with big advances in screening and treatment, at least for some.
WHITMAN: Apparently what happened was that white women were able to take advantage of those new developments, and black women not at all. And that's really unique in all of health that, say, in 25 years, death rates from a given cause do not improve.
The racial divide here has only gotten wider. As of 2005, black women were more than twice as likely to die of their cancer than white women. That's far worse than the country at large – more than five times worse than New York City.
WHITMAN: Everybody was very alarmed and disgusted by it, to be honest. And so we all got together and said, 'We need to try and figure out how to fix it.'
Whitman helped form a task force with doctors and scientists. Over time, they've turned more and more of their attention to one key link in the chain of cancer care: screening mammograms. These breast X-rays can find tumors smaller than a pea. By the time a woman can feel a lump, that tumor is probably much bigger.
WHITMAN: The bigger the tumor is, the harder it is to treat and get under control. So mammography is absolutely crucial in terms of finding the tumors early. And when they're found early, there's almost a 100-percent five-year survival rate.
The trouble is, black women in Chicago aren't finding their cancers as early. Researchers believe that's because black women aren't getting mammograms as often as white women And, new findings show that even when they do, the quality is worse.
COOPER: This is a plastic sleeve that act comes down and compresses the breast from top to bottom. And this whole unit actually turns…
Retha Cooper works in the mammography program at the city-run Englewood Neighborhood Health Center. This is one of the few places on the South Side where women can get free mammograms – women like Sharon Mays.
MAYS: I am a three year breast cancer survivor.
Mays looks younger than her 41 years, with carefully sculpted hair and copper-tinted lips.
MAYS: Me being an uninsured woman, I'd never had a mammogram.
She decided to get screened here. Then came a battery of tests, then an appointment at Mercy Hospital.
MAYS: They said to get undressed. I said, 'Why am I getting undressed just to get the results?' And the door opened, there were like five white coats. I just started crying immediately, because I already knew what it was when I saw the doctors come into the room. And they were like, ''Yeah, you have breast cancer, stage one, but it's early.
Early enough that treatment has kept her cancer-free for three years. But for women like Mays – unemployed, living in a low-income neighborhood – there aren't many places to go. And now there's one less. That mammogram machine here in the Englewood clinic – turns out, it's in mothballs. It's been broken since June. So until at least until next year, administrator Loys Holland is sending women to another city clinic: it‘s in Roseland, 10 miles away.
HOLLAND: The capacity is still there. It's just that economically, if I live on 64th and Lowe, I gotta get to 115th and Indiana, and there's no bus route.
The reason Englewood can't do mammograms right now is that it's waiting on a new, advanced digital machine. They got grant money for the machines over a year ago – but installation is proving to be expensive and slow. Research shows those digital machines give better quality results – but across the city, screenings for black women are much more likely to be done on older analog machines.
MARCUS: You know we talk about food deserts, there's a health care desert. Which, incidentally seems to be the same as where our food deserts are.
That's Elizabeth Marcus, chair of breast oncology at Cook County's Stroger Hospital. Women in poor, mostly black communities can still get mammograms. The state pays for them at a handful of places. But it costs time and money to get to those screening sites. Low-income women may not be able ditch work or find a babysitter.
Dr. Marcus says the upshot of the different barriers – economic, social, geographical – is that by the time many women get to her, their cancers are pretty far gone.
MARCUS: You know, late stage cancer can act erode out of the skin. It can bleed, it smells bad. When you get really bad lymph node involvement, it can be horribly painful. You wouldn't wish it on anybody.
Marcus says about one in four of her patients come in with late-stage tumors, compared to about one in 10 nationally And since she started at Stroger 13 years ago, that hasn't improved.
MARCUS: I'm getting kind of tired of watching 30 and 40 year old women come in in late stages.
Years ago researchers guessed that what screenings were available in black neighborhoods were lower quality than what was available to whites. Now preliminary research out of the University of Illinois at Chicago has found something like a smoking gun. Their analysis shows the mammogram films – we're talking about the x-ray pictures themselves – are worse quality for black women and poor women than for white or well-off women. Steve Whitman says this is kind of a dirty secret in the medical community.
WHITMAN: Everyone will acknowledge that there's a problem with access to mammography. But never, almost, is there a discussion of disparities in quality.
The quality may be worse because those digital machines are scarce, or the technicians may not be as well trained. Whatever it is, Whitman says this cannot go on.
The Breast Cancer Task Force is working out some practical solutions. They're working on getting money to train doctors in reading mammograms, which may help them catch more cancers. And they're roped 56 area health care providers into a huge consortium – an unprecedented cooperative to share data and get to the bottom of the disparities in quality.
Doctors like to talk about a continuum of care – a bridge from screening to cure. But for a sick woman in a tough Chicago neighborhood, that bridge has a lot of cracks. And researchers say too many women are falling through.