Study reports black women are at increasing risk for breast cancer

CHICAGO - The odds that a woman will die of breast cancer have been declining steadily for close to two decades - unless she's black.

According to an alarming report released Tuesday, not only are African-American women not part of the downward trend, their death rates are actually going up as rates for white women go down. And, for unknown reasons, the situation is worse in Chicago than in other parts of the country.

"While advances in mammography screening and breast cancer treatment in Chicago have benefited white women, these advances have not helped reduce breast cancer mortality for African-American women," said Alan Channing, president of the Sinai Health System, which released the report.

Calling on the medical community to improve screening and treatment, as well as access to care, Channing announced the formation of a task force that will try to figure out how to reduce the growing racial disparity in breast cancer death rates.

(The report did not analyze data for Hispanics, Asians or women of other races, all of whom have lower breast cancer rates than white and black women.)

Chicago's gap in breast cancer death rates is a relatively new phenomenon, according to the report compiled by the Sinai Urban Health Institute. In the 1980s rates were similar for blacks and whites: around 38 breast cancer deaths per 100,000 women per year. The rates started to diverge in the 1990s, as overall mortality rates began to drop thanks to improvements in treatment and early detection.

As of 2003, the last year for which statistics are available, the rate for Chicago's black women was 40.5 breast cancer deaths per 100,000, compared to 23.4 for whites-73 percent higher.

The gap in New York City is only 17 percent (35.8 for blacks, 30.7 for whites)-which "does suggest it's not just an issue of big urban areas," said Steven Whitman, director of the urban health institute.

For the U.S. as a whole, the mortality rate for white women is 25.2, compared to 34.6 for black women-37 percent higher.

Researchers have been trying for years to discover why black women in America have a higher risk of dying of breast cancer, even though they're less likely to get the disease. Some studies have indicated there are biological differences that may cause black women to get more aggressive types of breast cancer; others have found that black women are more likely to get inferior care.

Steven Whitman, director of the urban health institute, said the dramatic disparity in Chicago "cannot be explained by genetic or biological differences." Biology could account for a small percentage of the gap, he said, but not for the fact that the gap has been growing.

"Is someone going to argue that the genetics of black women has shifted in the last 23 years?" he asked rhetorically.

The problem with the biological hypothesis, said Whitman, is that "it takes the onus off the social and medical dimensions of the problem." Focusing on biology or genetics, he said, "is like seeing a herd of brontosauruses coming at you and studying their toenails."

The report, which has not yet been published, proposes three possible explanations for the disparity in mortality rates:

-black women get less-frequent screening mammograms,

-the mammography available to black women is of poor quality,

-black women get less effective or delayed treatment once breast cancer is diagnosed.

The Sinai document calls on area hospitals and breast centers to collect and share mammography quality measures as the first step toward improving services.

"In health care, what gets measured gets better," said Channing.

Mammograms, which are specialized X-rays, are difficult to read, and their effectiveness in spotting cancer early depends in part on how well they are interpreted. Federal law sets minimum standards for facilities that do the test but does not require them to keep any specific measures of accuracy.

The American College of Radiology has established quality standards and recommends that all mammography programs keep track of their performance. But many programs do not, and most do not release that data.

Last year the Institute of Medicine of the National Academies said the government should make mammography facilities collect statistics that can be used to measure their competency.

The Sinai report echoed that recommendation, saying every facility should calculate some standard quality measures, including the number of cancers detected per 1,000 screening mammograms. The report suggested that number should be in the neighborhood of 5 to 7 but noted that one inner-city facility found only 37 breast cancers in a series of 15,501 mammograms-a detection rate of 2.4 per 1,000.

To stimulate transparency and perhaps challenge other facilities to release their data, the report includes quality measures for Mt. Sinai Hospital (part of the Sinai Health System) and Mercy Hospital.

The task force announced Tuesday will be co-chaired by Ruth Rothstein, former CEO of the Cook County Bureau of Health and now president of the board of Rosalind Franklin University of Medicine; Sheila Lyne, CEO of Mercy Hospital and former commissioner of the Chicago Department of Public Health; and Donna Thompson, CEO of Access Community Health Network.

It will convene a summit of hospital and clinic officials in January and will issue a report by the end of next year outlining the steps participating health care institutions are taking to eliminate the disparity.

Calling the co-chairs "the three most powerful women in health care in Chicago," Whitman said, "I think the task force has a real chance at fixing this. I'm optimistic."

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(c) 2006, Chicago Tribune. Distributed by Mclatchy-Tribune News Service.