Breast cancer kills more blacks than whites in Chicago

Oct. 18--A study showing an alarming gap in breast cancer death rates for black and white women in Chicago has mobilized health experts to find the root causes and recommend within a year ways to reduce the unusually high mortality among African-Americans.

Why black women are more likely to die of breast cancer is unclear, but medical leaders said genetics, lack of awareness about breast self-examination, inability to afford routine mammograms and limited access to medical facilities may play crucial roles.

Some Chicago researchers are also beginning to look at whether the stress of social isolation and living in impoverished or crime-ridden neighborhoods might make some women more vulnerable to cancer.

Another possibility is that some facilities serving black women are doing a poor job of detecting cancers early.

"Women are dying--overwhelmingly poor and black women--because of inadequate quality of the mammography process. That's our hypothesis," said Steve Whitman, director of the Sinai Urban Health Institute, which conducted the study released Tuesday.

The study, which has not yet been published or undergone the scrutiny of peers, found that the odds that a woman will die of breast cancer has been declining steadily for close to two decades, yet African-American women have been seeing the reverse. (The report did not analyze data for women of other races.)

As recently as the 1980s, mortality rates for black and white women in Chicago were both around 38 breast cancer deaths per 100,000 women per year, according to the study. The rates started to diverge in the 1990s, as overall mortality rates began to drop thanks to improvements in treatment and early detection.

By 2003, the last year for which statistics are available, the rate for Chicago's black women was 73 percent higher: 40.5 breast cancer deaths per 100,000, compared with 23.4 for white women.

For the U.S. as a whole, the mortality rate for white women is 25.2, compared with 34.6 for black women--37 percent higher. The study reported the gap in New York City was only 17 percent (35.8 for blacks, 30.7 for whites), which suggests "it's not just an issue of big urban areas," Whitman said.

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 found biological differences that may cause black women to get more aggressive types of breast cancer. Experts say black women are more likely than white women to have a combination of three genetic defects that makes their tumors harder to treat.

"We've known for years that African-American women have a more aggressive type of breast cancer compared to white women," said Dr. Virginia Kaklamani, an oncologist at the Northwestern University Feinberg School of Medicine. "One of the reasons for that is that the kind of breast cancer they get is genetically worse."

At the University of Chicago, meanwhile, a large federally funded study is under way to look at social factors that might bring about biological changes that lead to breast cancer. The team includes specialists in the medical, biological, behavioral and social sciences.

70% to 80% environmental

"We think the black-white disparity is due to complex interactions of genetic and environmental factors. By joining together is the only way we're going to get a handle on them," said study leader Sarah Gehlert, director of the Center for Interdisciplinary Health Disparities Research.

"Between 70 and 80 percent of all breast cancers are due to sporadic mutations, not inherited mutations. That means it's things that happen in the environment," Gehlert said.

"We think that if you live in really adverse circumstances in a neighborhood with a lot of crime, so the threat's always there, you'll be afraid to go out and will develop what we call a dysregulated stress response," she said. "And you'll be more likely to have spontaneous mutations of the breast cancer genes."

Gehlert said her study is based on the work of U. of C. psychologist Martha McClintock, who showed that socially isolated female laboratory rats suffered an increase in spontaneous breast cancers.

"We're testing this hypothesis in Chicago and Gary on 233 newly diagnosed African-American breast cancer patients," Gehlert said. "We go into their homes and look at their neighborhoods. Then we examine their tumors after they've been biopsied to see if they're due to spontaneous mutations or are inherited."

Experts also noted that black women also are more likely to get inferior care, fail to seek appropriate testing and be unable to afford routine mammograms.

Sandra Stewart, 55, who lives on Chicago's South Side, said she hadn't had a mammogram in 10 years when she felt a hardness in her breast one morning last October--breast cancer awareness month.

"Most of us can't afford it," she said. "I didn't have any insurance."

Scared, she called a cancer hot line she'd seen on TV and was able to receive a free mammogram. "They found an advanced cancer," she said. "The very same day, they sent me up for a biopsy."

The Stand Against Cancer project arranged for Medicaid to cover her treatment, and today Stewart is in complete remission.

To address the idea that the mammography available to black women may be of poor quality, the Sinai report calls on area hospitals and breast centers to share mammography quality measures as the first step toward improving services.

"In health care, what gets measured gets better," said Alan Channing, president of the Sinai Health System.

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. 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 the data if they have it.

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

Summit in January

The task force organized to figure out how to reduce Chicago's racial gap in breast cancer death rates will call a summit meeting in January with leaders in radiology, mammography, medical financing and others concerned about breast cancer.

The task force 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; Sister 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.

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."

jperes@tribune.com

rkotulak@tribune.com

pgorner@tribune.com

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Copyright (c) 2006, Chicago Tribune

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