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Cancer in the Neighborhood
The focus on African-Americans is long-overdue, especially since this group has much higher mortality rates for many forms of cancer. Even when the incidence of a certain form of cancer is higher among whites, the survival rate is nearly always lower for blacks. The reasons are not clear, but suspected culprits include differences in access to screening or treatment, stage at diagnosis, and aggressiveness of disease.
Breast cancer is a good example of this anomaly. While white women in states like Tennessee are slightly more likely to be diagnosed with breast cancer than African-Americans, African-American women are far more likely to die from the disease.
“In the 1990s, women in the African-American community were telling me that younger women were being diagnosed with breast cancer, especially aggressive forms of breast cancer, but I don’t think researchers were always listening to the community,” explained Elizabeth A. Williams, Ph.D., associate director of Minority Affairs for Vanderbilt-Ingram. “Now scientists have discovered that aggressive forms of breast cancer are disproportionately affecting African-American women. If as scientists we’re off in our ivory towers and are not listening carefully to people affected by cancer, we can miss opportunities for early diagnosis, prevention and control. Research and communication is not a one-way street. It is a two-way street between scientists and communities and we need to recognize that.”
Williams said it is becoming clear that the burden of cancer is being borne disproportionately by people of color. This health care disparity has its roots in the tangled web of the South’s political and social history, including segregated housing patterns. People living in low-income neighborhoods may find it more difficult to adopt a lifestyle that can protect them against some cancer risk factors.
“We do know there is a significant lifestyle component linked to cancer incidence,” said Bettina Beech, Dr.P.H., associate director of Health Disparities Research for Vanderbilt-Ingram. “If we increase fruit and vegetable consumption, decrease fat consumption and increase physical activity, we can avoid a huge percentage of cancer cases. But it is not that simple for people living in some areas. For low-income individuals, regardless of whether they are minorities, there is reduced access to grocery stores with high-quality produce in many neighborhoods. By the same token, if they don’t have sidewalks or safe neighborhoods, those structural environmental issues impede their ability to be physically active.”
Beech points out that those same low-resource neighborhoods may have drive-through liquor and tobacco stores that are close to schools and housing developments. She believes this easy access to unhealthy products isn’t as prevalent in high-resource areas.
Gaps in access to health care, both for low-income individuals as well as minorities, also exist, Williams said.
“Historically, when you look at people of color in relation to the majority population, we have always had a two-tiered medical system in the United States, particularly in the Southern states,” said Williams. “What continues to persist is differences in the way people are perceived within the health care system. That has an effect on how people access the health care system, whether or not they actually make it to the front door of the system, and how they are received once they do arrive.”
Beech points to a 2002 study on unequal treatment by the Institute of Medicine which found clear-cut evidence that longstanding racial attitudes affect patient treatment.
“The literature has consistently shown this disparity in treatment and access,” Beech said. “The IOM report demonstrated that even when providers are presented with fictitious patients with the same patient profile, with race as the only difference, physicians often provided a different diagnosis, different prognosis and different course
of treatment for the patients.”
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