It Doesn't Have to Be This Way; A Variety of Cultural and Economic Factors Contribute to the Tragic Reality That Women in Northeast Florida Routinely Die of Breast Cancer Who Could Have Been Saved

By Conner, Deirdre | The Florida Times Union, October 18, 2008 | Go to article overview

It Doesn't Have to Be This Way; A Variety of Cultural and Economic Factors Contribute to the Tragic Reality That Women in Northeast Florida Routinely Die of Breast Cancer Who Could Have Been Saved


Conner, Deirdre, The Florida Times Union


Byline: DEIRDRE CONNER

For Evelyn's sake, don't wait forever.

For Paula, conquer your fear.

For Cathy, never give up.

For Shahla, consider the community.

They want you to know: Breast cancer doesn't treat all people equally. People sometimes like to say that cancer doesn't discriminate. But it does.

Women without health insurance, African-American women, poor and rural women are all more likely to die of breast cancer. And in Northeast Florida, home to some of the best hospitals and medical professionals in the world, women routinely die of breast cancer who could have -- should have -- survived.

Despite all the walks, all the ribbons, all the programs and campaigns and foundations, there are women here who never get a mammogram. There are women who keep breast lumps a secret. There are women who don't want a diagnosis. And there are women who have a diagnosis but no treatment.

Breast cancer disparities are easy to describe with numbers and graphs. The women whose stories are behind the figures don't seem quite so indifferent.

PART 1: EVELYN AND HER SISTERS

Evelyn Ray-Rogers had two sisters. Now she has one.

Highway robbery, she calls it, because it didn't have to be this way.

All three sisters got breast cancer. So when Ray-Rogers' oldest sister was the last to be diagnosed, her two cancer-surviving younger sisters couldn't believe what they heard: She had advanced-stage breast cancer.

"I believe my sister was either too fearful or too proud to act upon the change in her body that she saw," Ray-Rogers said.

Fear, myths and cost are what keep many women in the black community from getting treated quickly enough, Ray-Rogers said. She recently attended a funeral of a childhood friend, an educated woman who died of cancer. She hadn't seen a doctor in five years.

"It doesn't have to happen," she said. "It makes me sad. It makes me angry."

Studies have shown that breast cancer afflicts African-American women at a lower rate than white women. But black women are more likely to be diagnosed at a younger age. They are more likely to get aggressive forms of breast cancer. And they are more likely to die of it.

In 2003, the rate of breast cancer in Duval County was 206 per 100,000 women in their late 40s vs. 180 per 100,000 for white women. African-American women were 13 percent more likely to die, according to Dana Fields-Johnson, Director of the Duval County Health Department's Chronic Disease Prevention Services.

Income and rates of health insurance coverage explain some of it. So does historical mistrust of the medical system that delays women from seeking care, experts believe.

But even when controlled for income and insurance status, black women still get earlier and more aggressive cancers.

Gerardo Colon-Otero, a Mayo physician, and participant in the clinic's "Live Well, Be Well" initiative, said the disparities require more research. It's exactly why clinical trials need a more demographically representative sample of participants, Colon said.

The clinic makes a special effort to reach out to minorities to encourage participation in clinical trials, needed to overcome historical distrust.

Constance D. Kennedy, 55, a 13-year survivor of breast cancer, was one of the ones who got breast cancer at a young age. In the mid-'90s, cancer was The Big C. Things are different now, she said -- there's more support, more understanding, less fear.

But when it comes to medical research, there's still some hesitation on the part of African-Americans that traces its roots to the trauma of history: racist and harmful research projects such as the Tuskeegee Experiment.

That's why it's important for physicians such as Colon to be out in the community, said Monica Albertie, coordinator of Live Well, Be Well, which was begun in late 2006. …

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