This Issue

Cancer and health disparities

Increasing access key to closing the gap

Tips to close the gap

Q & A

Breast cancer is the leading cause of death
in women.
Cardiovascular disease kills more women than all cancers combined.
Surgery can cause
cancer to spread.
Exposing the tumor to air does not cause cancer to spread. Often surgery reveals a more extensive cancer, which may cause people to think that surgery worsened the disease.
Cancer is contagious. It is not possible to “catch” cancer from someone. However, through unsafe sex, you can become infected with certain viruses, such as hepatitis C and HPV, which can lead to liver and cervical cancers, respectively.
Living a healthy lifestyle
can prevent cancer.
Although exercise, not smoking, a healthy weight and a healthy eating plan can reduce the risk of cancer, they cannot provide an absolute protection against the disease. Other factors, such as genetics and environment may come into play.

Myths busted

A disturbing difference

A life saving timetable

Risk factors

Take the
first step

A disturbing difference

How much is too much?

honeyThe body requires glucose to provide energy to do its job. We can get that sugar naturally from fruits, vegetables, milk and whole grains, which are full of nutrients. Added sugars, on the other hand, are sugars and syrups added to foods during preparation or at the table. These added sugars bring with them sweetness and calories, but lack nutrition. The American Heart Association recommends a daily limit of added sugars according to the information below.

Women’s daily limit
6 teaspoons = 100 Calories = 25 grams

Men’s daily limit
9 teaspoons = 150 Calories = 37.5 grams

Oral, Head and Neck Cancer
Awareness Week is May 8 – 14.

Photo by Vannessa Carrington/Mass. Eye and Ear

Get screened for head and neck
cancer. It’s free, quick and painless.

Boston Medical Center
Moakley Building Lobby
830 Harrison Avenue
Date: April 2
Time: 8 a.m. - noon

Tufts Medical Center
860 Washington Street
Date: May 12
Time: 2:30 – 4:30 p.m.
Mass Eye and Ear
243 Charles Street
Date: May 13
Time: TBA
Dedham Family Dental
Dr. Helaine Smith
30 Milton Street, Dedham
Date: May 11
Time: 9 a.m. – 1 p.m.

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
Remember to call ahead to confirm
time and date
of screenings.

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Risk Factors

A risk factor is a characteristic that is likely to increase your chance of a particular disease. Having a risk factor does not mean you will get the disease. Likewise, not having one is not a guarantee against it. Some risk factors for cancer are beyond a person’s control, while others can be influenced by behavior and lifestyle.

Factors you can control

• Smoking and tobacco use
• Inactivity and weight
• Unhealthy diet
• Alcohol consumption

Factors beyond your control

• Age
• Race
• Personal or family history of cancer
• Genetics/inherited mutations

Cancer and health disparities

African Americans are suffering from cancer at far greater rates, but the numbers are improving ever so slightly. Researchers say early screenings are part of the reason.

Cancer, the second leading cause of death in this country, is the uncontrolled growth and spread of abnormal cells. The American Cancer Society estimates 1,596,670 new cases of cancer in 2011 and almost 572,000 deaths. Cancer strikes all races and ethnicities, but African Americans — particularly black males — are disproportionately impacted.

Talk about a cultural change. Hawo Adan-Abdi, 51, readily admitted she was not excited about the prospect of regular breast cancer screenings. But the providers at Whittier Street Health Center (WSHC) persisted and when she saw that women emerged from the test unscathed she eventually relented.

Adan-Abdi is not alone. Many women share her fears. WSHC personnel found that out firsthand when they conducted focus groups with Somali women to understand their perceptions of the test and the disease. It was an eye-opener.

The participants likened the mammogram to a “pancake machine that squeezes your breast.” While all understood its purpose, all commented on its discomfort. “When I hear mammogram I am in pain” was one response.

But Adan-Abdi is not complaining. The discomfort of mammograms pales in comparison to fleeing war-torn Mogadishu and the perils of living in a refugee camp with five of her children. There was no such thing as yearly physicals in her native country, much less cancer screenings. “Back home you go to the hospital only if something is wrong,” she explained.

And that’s the point of screenings — to detect “something” early enough to increase the odds of survivability. But the reality is pretty grim when it comes to cancer and its impact on African Americans. Blacks have the highest death rate and shortest survival of any racial and ethnic group for most cancers. Nearly 169,000 new cases of cancer are expected in African Americans in 2011 — and roughly 65,500 deaths — according to the American Cancer Society (ACS).

It sounds bleak but when one considers the starting point, progress has been made. Since the early 1990s, the incidence rate of most cancers has decreased or stabilized. Death rates have declined as well — by 2.5 percent a year in men and 1.5 percent a year in women. Particularly notable is lung cancer, according to the ACS, where rates of death have decreased faster in African American men than white men. This improvement is significant given the fact that lung cancer is the leading cause of cancer deaths.

Despite these improvements, the gap persists between blacks and whites in cancer cases and deaths. Black men have the highest death rates of any group, most notably in prostate cancer where black men die at two to five times the rate of all other races.

Black women, on the other hand, pose a different, and often puzzling, picture. While the incidence of cancer overall is highest among white women, blacks have a higher death rate. For instance, while white women are diagnosed more frequently with breast and uterine cancer, the first and fourth most common cancers in women, blacks die of both more often.

It took a bit of coaxing to get Hawo Adan-Abdi (right) to start screenings for breast cancer when she came to this country from Somalia. Pictured with her is her son, Abdirahman Abdi.
(Photo courtesy of Rachel Boillot,
Boston Housing Authority)

What researchers have found more troubling is that those rates occur even though black women are regularly screened, and at a rate higher than white women, especially here in Massachusetts.

According to the 2010 Behavioral Risk Factor Surveillance System (BRFSS), a survey developed by the Centers for Disease Control and Prevention, more than 94 percent of black females aged 50 or older in Massachusetts reported that they had received a mammogram within the past two years. This percentage exceeded that of all other women in the state — and in the country, for that matter.

Pap smears show similar results. More than 93 percent of black women in Massachusetts — compared to 86 percent nationwide — said they had received the test within the past three years.

The numbers begin to recede in regards to colorectal cancer screening, but still are higher than expected. Almost three-fourths of black adults aged 50 or older interviewed in the state said they had received a sigmoidoscopy or colonoscopy. White adults exceeded this number by only 4 percent. Prostate cancer screening is a totally different story altogether — for all races. The BRFSS reports that only 54 percent of men aged 40 and above — most of them white — had had a PSA (a blood test to help detect prostate cancer) within the past two years.

Cancer health disparities are not defined by race alone. Differences are noted by gender and age. Females have a higher incidence of breast and thyroid cancer than males. Uterine cancer is more common after the age of 60, while Ewing’s sarcoma, a type of bone cancer, tends to afflict teenagers.

And it’s not only blacks that suffer cancer disparities. Latinas have the highest incidence of cervical cancer. Asians are more afflicted with liver and stomach cancer, while Native Americans suffer their share of kidney cancer. Whites are not immune. They have a higher incidence of cancers of the skin and blood, such as leukemia and lymphoma.

Even geographical location has an impact. New cases of lung cancer are lowest in a handful of states, such as Arizona and California, while the highest numbers can be found in Maine and Kentucky.

Cancer Health Disparities:
Challenges and Opportunities

Video from American Association for Cancer Research
But more than anything else, experts explain that it is a person’s socioeconomic status (SES) that fuels cancer’s development. The National Cancer Institute (NCI) notes that people who are poor and uneducated, lack health insurance and are medically underserved are impacted the most.

Health literacy presents another barrier. Those uninformed about screenings or warning signs and symptoms of cancer are less likely to take action, while language and cultural differences hinder communication.

But misperceptions and attitudes about cancer, regardless of a person’s status, pose another problem altogether.

Researchers at the University of Chicago analyzed perceptions of breast cancer treatment among roughly 450 African American residents of Chicago’s South Side. Participants in the focus groups cited mistrust of the medical establishment and that quality of care is related to quality of health coverage.

But it was mostly fear that prevailed. The participants expressed fear that surgery can activate breast cancer, that radiation makes it spread faster and that chemotherapy was ineffective.

Perceived discrimination was also a barrier, as reported in a study from Stanford University. People who perceived discrimination from their health care providers were less likely to be screened for breast or colorectal cancer.

Some people are just fatalistic and believe that recovery from cancer is not possible.

But the health system cannot escape blame as a player in the issue of cancer disparities. Two-thirds of patients who were newly diagnosed with cancer were unable for a variety of reasons to obtain timely appointments with oncologists, according to a recent review by the University of Pennsylvania. Schedulers were not always available, medical records had disappeared or appropriate referrals did not materialize.

More disconcerting than scheduling complications is a lesser quality of treatment rendered to black cancer patients. In 2008 the ACS found that over a 10-year period black patients covered by Medicare were less likely than whites to receive the recommended types of care.

For instance, African American women with breast cancer who underwent the breast-conserving lumpectomy did not always undergo radiation therapy, although the combined treatment is considered the gold standard.

Despite the obstacles, Adan-Abdi said she is a convert now. “I am no longer afraid,” she said. Now she gets a yearly physical and handles her mammograms like a pro. She hasn’t stopped at mammograms. She’s into Pap smears as well. “It’s good to know,” she said. “The sooner the better.”

Cancer screening was new to her. And scary. So scary she ran from it for a while. She admits now that she sometimes did not show up for appointments. One time, she says, she was fasting for Ramadan; other times she just forgot. But looming over these tests was the concern that they were causing more harm than good.

Her fears became real when she was “recalled” after her first mammogram. Her results indicated she had a suspicious lesion that required additional imaging evaluation. Fortunately for Adan-Abdi, further testing proved that the lesion was negative. But at one point, the doctors were talking about a biopsy.

Adan-Abdi’s behavioral change does not end with her own health care. She makes sure her kids are healthy too. “It’s best to check for something before it gets bad,” she said.