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

Increasing access key to closing the gap

See a doctor regularly, get the recommended screenings and take part in your care.

Dr. Christopher Lathan, a thoracic oncologist at Dana-Farber Cancer Institute, has his work cut out for him. As director of the Cancer Care Equity Program at the Institute, his goal is to make sure that minorities have access to and receive the quality of care they need to combat their disease.

And that’s not easy.

There have been some improvements over the years. “The mortality rates for cancer have decreased overall,” he said. “But the difference between the races remains the same.”

And the disparities start from the first step in fighting the disease — screenings. Nationwide minorities are less likely to receive recommended screenings for many reasons. Lack of insurance and transportation and loss of income when away from work are all factors. But it’s that next step that concerns Lathan even more.

It’s a challenge to get people to follow up after a positive finding on a screening test. This is often the time when people run scared. Also, other commitments like family or a job might take precedence. More often than not, it’s easier to postpone treatment when you’re feeling fine.

“It means another day off from work,” Lathan explained. Some people might think: “Why should I take a day off work and pay another co-pay when they’re going to tell me something I don’t want to hear?”

A recent study published in the Journal of the National Cancer Institute bore that out. Of those referred for additional testing following an abnormal sigmoidoscopy, a screening tool for colon cancer, only 62 percent of blacks compared to 72 percent of whites followed up for additional testing.

Christopher Lathan, M.D.
Cancer Care Equity Program
Dana-Farber Cancer Institute

Lathan places some of the blame on the medical profession. “It’s up to the doctor to make a clear path,” he explained. “The key is to know your community. Then make the system easier by putting in structure [for follow-up]. Have someone call and tell the patient where to go next.”

After an initial screening, the next step can be confusing. While the protocol for breast cancer is well devised, it is not as clear cut with other types of cancer, Lathan said. The patient may require another test, a visit with a surgeon or a visit with an oncologist, a medical doctor who specializes in the treatment of cancer.

Lathan acknowledged that there are many barriers to care that may seem insurmountable by minorities. “The single biggest cause of lack of treatment is access,” he said. But he’s not necessarily referring to the number and location of health facilities. “Some have access but don’t know it,” he explained, referring to the state-run insurance plan based on income in Massachusetts. Or people may not know where to go although health facilities are available.

Lack of education about cancer is another deterrent. Extended families, which are common in the black community, can provide a high level of support for a relative with cancer. But they can work against you as well. Incorrect information is filtered down.

Lathan is a strong advocate of increasing blacks’ participation in clinical trials, but he recognizes that many of these trials are not accessible. “You [health providers] must go to the community,” he said.

Although it is not possible to always prevent cancer, there are steps a person can take to reduce its risk. Never smoke or quit if you do, Lathan advised. The majority of lung cancers are caused by tobacco use. Lifestyle is key. Diet is closely linked to many cancers. For instance, high consumption of red meat can increase the risk of colon cancer.

Physical activity and exercise as well as weight control are important. Obesity is a strong risk factor for uterine cancer and breast cancer, especially for postmenopausal women.

The federal government has even weighed in to improve access. The Centers for Disease Control and Prevention has established programs that offer free or low cost testing for breast, colon and cervical cancer (877-414-4447). President Barack Obama has taken it a step further and has eliminated co-insurance and co-pays for several tests, including those for cancer, through the Patient Protection and Affordable Care Act.

Additionally, mobile vans, such as the Mammography and Blum Vans run by Dana-Farber Cancer Institute, offer screenings throughout the community for breast and prostate cancers.

In spite of everything, Lathan is optimistic and offers a primer to help keep cancer at bay. His first advice is to see a doctor regularly. “You must take care of your health,” he advised, and get the recommended screenings. His second directive is to take part in your care. Ask questions, he said, and advocate for yourself. Fight if something does not seem right. His last is to demand excellence of care. “You deserve the best possible treatment,” he said.

Dr. Christopher Lathan’s thoughts on cancer health disparities

Video from American Association for Cancer Research