Tools to Close the Cancer Gap
By Olivia Cobiskey
While you are at work today, five African-American women will die of breast cancer. Another five will die while you sleep. This happens every day in America; they aren't dying because they are black, they are dying for reasons advocates are still trying to understand.
Wynee Giles, a 36-year-old African-American woman, has been working in the health-care field for 17 years. As a licensed practical nurse, she's direct, even blunt, with her patients. She talks to her family about the importance of annual exams. She's even taught her daughter how to do her monthly breast self-examinations.
But Giles has never had a mammogram herself.
Giles is not alone. In Florida, some 480,000 or 60 percent of women older than 40, fail to get mammograms each year.
Giles, who lost her father to male breast cancer, is at high risk for the disease. Now she works for one of the few doctors in Pinellas County who will take patients without charge.
Two programs provide women with free health-care services. The first is a voucher provided by the Mammogram Voucher Program and privately funded by the Susan G. Komen Foundation. This program targets women between 40 and 49 years old.
The second is a federal grant provided to the Florida Department of Health for a breast and cervical cancer-screening program that enables women to get clinical breast exams, Pap smears and mammograms. This program targets women between 50 and 64 years old.
To qualify for the programs, a participant must be from a low-income household and have no insurance.
However, if a woman younger than 40 has an abnormal clinical breast exam, the programs will provide a free mammogram.
By the time women get to Dr. John Lee's office, they have already had an abnormal mammogram, said Giles. Giles often is put in the position of explaining to the women that if they fail to do "A, B, C or D," they will die. She's found that being blunt is necessary.
"Cancer is a non-discriminatory disease," said Giles. "Sometimes it takes longer to convince people."
Although Caucasian women are more likely to get the disease, African-American women are more likely to die from it. Advocates attribute this to a lack of health insurance, lack of transportation and a lack of access to health-care education. And many said African-American women traditionally put the needs of their families before their own.
When it comes to her own failure to get an exam, Giles is at a loss for words.
"There really isn't a reason," she said.
"I don't like going," she adds quickly. "[Doctors] always find something wrong."
"Women are fearful of the unknown," said Voncea Brusha, president of the greater Gainesville chapter of the National Black Nurses Association, Inc. "There is this preconceived notion that if they ignore it, it will go away. They keep putting it off until it's too late."
There are several excuses why women don't get mammograms and several more on why they should be reminded to get one, said Brusha, whose motto is "go to the people."
Go into the community, she encourages health-care providers, go where the people are: to the churches and the neighborhoods.
"An ounce of prevention is better than a cure," she said, reminding women that they have a double role: taking care of themselves and encouraging others to do the same.
"Live by example," the 60-year-old Brusha said. "Let them see you going to the doctor. Ask them, 'Did you get your Pap smear, your breast exam?'"
Fear isn't the only problem. Poverty, advocates say, is one of the main issues keeping women out of the doctor's office. According to the Census Bureau, more than 2 million blacks in Florida live below the poverty level. But "free" isn't enough for some.
Angyla L. Bonner-Bell said it's still frustrating. Even with free information and free mammograms, women are still reluctant to seek care, she said.
As the breast health education coordinator for the Coalition for a Safe & Drug-Free St. Petersburg, Inc., Bonner-Bell was awarded a grant through the Susan G. Komen Breast Cancer Foundation to educate the Midtown area of St. Petersburg on the effects of breast cancer in African-American women.
"It's hard to explain," Bonner-Bell starts. "We suffer for lack of knowledge, unnecessarily."
The five-year survival rate for African-American women is lower than the survival rate for Caucasian and Latina women. Only 69 percent of African-American women reach their fifth-year remission anniversary.
Advocates cite several factors for the low survival rate among African-American women. According to a study in the American Journal of Public Health, women go untreated, are under-treated or treated by non-surgical methods, because many lack insurance and are unknowledgeable of the disease.
And now advocates are adding another reason to the list of why African-American women are dying of the disease on such a disproportionate level-genetics. An estimated 250,000 women in the United States carry the BRCA 1 or BRCA 2 gene. BRCA is short for BReast CAncer gene 1 & 2.
And although genetically Ashkenazi Jewish women carry the BRCA 1 or 2 gene at a higher rate than any other minorities, a recent study found that the actual tumor cells in African-American women grow more rapidly, leading to more aggressive cancers at an earlier age, said Bonner-Bell.
Another study, by Sue A. Joslyn, associate professor of epidemiology at the University of Northern Iowa, and her colleague, Michele M. West, of the State Health Registry of Iowa and the University of Iowa, found African-American women are more likely to be diagnosed with estrogen and progesterone receptor-negative tumors, which advocates said contributes to the poorer prognosis when compared with hormone receptor-positive tumors. Therefore cancer in African-American women was less responsive to hormone treatment.
But advocates said it is important to remember most breast cancer is not inherited or genetic. This is not an excuse to delay a mammogram, they remind women.
Even with her unfaltering commitment to women's health, Bonner-Bell has yet to get a mammogram.
Bonner-Bell knows she has to get a mammogram, she knows she needs to be able to testify to the women she is encouraging to seek help.
"I have no excuse," she adds, "that's the bottom line."
In Florida there are 800,000 women who, because of age alone, are at risk for breast cancer and 20 percent of these women do not have health insurance. Every year 7,000 of these women will have a breast biopsy because of a suspicious lump or abnormal mammogram, and 2,250 will be diagnosed with breast cancer. Seven hundred and fifty of these women will be diagnosed in the late or third stages of the disease, and 500 women will die.
Each woman interviewed is adamant when it comes to her friends, family and community: have a breast exam when you are 20, have a breast exam at least every three years between age 20 and 39. Have a breast exam every year if you are more than age 40.
However, all the women agree they are not as adamant when it comes to their own health.
"Women tend to put themselves last," said Terri Keys, especially in the African-American community.
Keys, united coordinator at the Edward White Hospital Center for Wound Care and Hyperbaric Medicine, lost her 31-year-old cousin to breast cancer.
"I'm a procrastinator," said Keys, when asked why she hasn't scheduled her mammogram yet.
Keys, who will be 40 next month, said she knows she has to move herself to the top of the priority list.
"If I'm not around, who's going to take care of them," Keys asked?
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