Pamela Cromwell regards herself as a fighter, not a cancer survivor.
Cromwell was 29 when she was diagnosed with breast cancer and told that she only had six months to live.
Five years later, she is battling Stage 4 metastatic breast cancer, a stage of cancer where the disease has spread.
Cromwell first became aware that something was wrong when she felt a lump in her left breast while showering. When she first went in for testing, medical professionals thought she had a cyst. Six months would go by before she was diagnosed with an aggressive form of breast cancer that was moving rapidly.
After undergoing chemotherapy, radiation and surgery, she thought she was in remission, but she was not. The cancer returned to her right breast.
Two years ago, she decided to turn to Cancer Treatment Centers of America (CTCA) in Philadelphia for her oncology care.
“A lot of people think I’m in remission which I’m not,” said Cromwell, who undergoes hormonal treatments once a month at CTCA.
She has not let cancer deter her from continuing to engage in one of her favorite pastimes — kickboxing. She still commutes from Plainsville, N.J. to New York for her full-time job as a financial analyst. She doesn’t believe in putting blocks on herself.
“Because of a combination of prayer, great people in my life and my determination to be stubborn, I’m in a very good state in my life. It’s just because I finally learned my lesson, that I had to take my life back,” said Cromwell, who is 34.
“I don’t walk around thinking this could be my last year in life. I just do what I have to do.”
She wants others to understand that the face of breast cancer goes beyond the typical portrayal of 45- or 50-year-old women.
“I think that people feel more comfortable with the idea that you have cancer, so that means you should be in bed, bald and not able to move, and the fact that I don’t look like a typical cancer patient means they want to say I’m in remission and I’m not,” said Cromwell.
She shares her story at a time when African-American women are more likely than white women to be diagnosed with breast cancer before age 45 and are also more likely to have more aggressive types of breast cancer.
“I just feel like people need to understand that cancer is turning into a chronic disease and people are dealing with it long-term. I feel like the world is catering to the survivor. All due respect, I don’t consider myself a survivor, I am a fighter and that’s how I like to be classified,” Cromwell said.
As a younger person coping with cancer, the newly released movie titled “50/50” resonates with her, she said. The film stars Joseph Gordon-Levitt and Seth Rogen, who portray best friends whose lives are changed by a cancer diagnosis at the age of 27, and sheds some light on the physical and emotional facets of living with cancer.
“The movie was phenomenal because it was real. It was not pretty. The movie was on target,” said Cromwell, who appreciated the film’s honesty.
When Cromwell first came to CTCA, Dr. Shayma Kamzi, a medical oncologist and hematologist, had to inform her that she had metastatic disease. Prior to her first visit to CTCA, she underwent a CT scan that revealed the cancer had spread from her breast to the bones.
“Of course she was shocked, and this came as a surprise, but she rose above it and really has fought very hard,” Kazmi said.
“She has a quality of life where she’s able to work full time and really be active and feel good and normal. She’s done really, really well. Obviously lengthening someone’s life is one thing, but adding quality to that life is also very important,” said Kazmi.
Since she joined the CTCA staff two and half years ago, Kazmi has treated a number of patients who are in their 30s and 40s for various forms of cancer.
“We do see a higher percentage of these very aggressive tumors and young patients tend to have a more aggressive disease and we don’t quite know why, and that’s true all across the board,” she said.
“I see a lot of younger women with breast cancer, and I think there are a lot of issues that people don’t focus on,” she said, noting that there are concerns for younger women about sexuality and fertility.
A movement to spread awareness about breast cancer will get underway this weekend.
The George E. Thorne Development Center is hosting the sixth annual “Praise Is the Cure Week of Hope, Health and Healing” — an event that recognizes the plight of African-American breast cancer patients, survivors and their families.
Anita T. Conner, a 13-year breast cancer survivor, expanded GETDC in 2005 to incorporate Praise is the Cure as a primary initiative.
“God spared me, so I believe he spared me to help somebody else,” said Conner, who is a prominent accountant.
“Our vision is to create a community with less victims and more breast cancer survivors — and our mission is do that by motivating, educating and encouraging African Americans to get their screenings and treatments.”
Conner’s focus on breast cancer awareness comes at a time when more African-American women are dying from the disease than any other ethnic group.
The free event kicks off on September 25 with Praise Sunday, where more than 50 houses of worship will celebrate breast cancer patients and survivors and raise awareness about breast health through pulpit presentations and the dissemination of life-saving information to their constituents. More than 20,000 pieces of breast health literature will be distributed during Praise Sunday.
A children’s festival is scheduled for September 28 at the North Philadelphia YMCA and September 29 at the Abington YMCA. A highlight of the festival includes readings of the book “My Mommy Has Breast Cancer, But She Is Ok!” by survivor Kerri M. Conner. The event is expected to reach about 300 children and their parents.
“Breast cancer affects the whole family, especially our children. As adults we often don’t know how to talk to our children about difficult situations. This gives us an opportunity to bring a very difficult situation to a children’s level and also to help educate the parents on how to talk to their children about things that are going on,” says Conner.
October 1 marks a jam-packed day for the Praise is the Cure Week. The day features a health fair with free mammograms and other screenings, wellness workshops, educational activities and a pampering party for breast cancer patients and survivors. Women and children from the shelter system are being bussed in to participate in the activities.
The breast cancer survivors pampering party serves as the highlight of the day, where survivors will be treated to full body massages, facials and manicures.
A key activity also includes the “Real Men Wear Pink…Taking Care of Others and Yourself” forum. The men’s only forum offer participants an opportunity to talk about health issues. Health columnist Glenn Ellis will serve as a key presenter during the men’s forum.
Praise is the Cure Week concludes with a breast cancer survivor procession and a benefit gospel concert featuring Hezekiah Walker and LFC and The Brockington Ensemble. The October 1 activities will be held at the Mt. Airy Church of God in Christ, 6401 Ogontz Ave.
Since its inception, Praise is the Cure has reached over 50,000 Philadelphia area residents and has raised more than $200,000 to support year round program efforts.
Honorary community members of Praise Is The Cure include National Association of Black Journalists Founder Sandra Long and Vice President of Community Affairs, Independence Blue Cross, Lorina Marshall-Blake. Honorary co-chairs state Sen. Vincent Hughes and actress Sheryl Lee Ralph are also advocates for Praise Is The Cure.
To register for the event, call (215) 635-1025.
A higher incidence of secondary breast cancer is seen among Black women regardless of age, research has found.
The findings were highlighted during a press call from the fourth American Association for Cancer Research conference on The Science of Cancer Health Disparities held September 18–21 in Washington, D.C.
The teleconference was hosted by Chanita Hughes-Halbert, director of the Center for Community-Based Research and Health Disparities at the University of Pennsylvania.
When cancer is diagnosed in women younger than 45 years old, the incidence of primary breast cancer is higher among Blacks than among whites — and the cancer tends to be more aggressive.
“While the incidence of breast cancer is generally higher among whites for first-time diagnosis, we found the incidence of the second contralateral diagnosis was higher among Blacks,” said lead researcher Nsouli Maktabi Hala, Ph.D, graduate of George Washington University.
“Our findings were unexpected, since Blacks have a higher mortality rate than whites from the first cancer, so you would expect Blacks to have lower rates of second cancers.”
The research also found that when cancer is diagnosed at an older age, the incidence is higher among white women. Since most breast cancers are diagnosed in older women, the overall incidence is higher in whites, said Maktabi.
Maktabi said about four percent of all breast cancer patients will present with a second primary cancer.
“Collectively our findings should urge physicians to watch patients carefully for the second breast cancer in the contralateral breast, especially in the first six to 10 years following the diagnosis of the first time,” Maktabi said.
The researchers used the Surveillance Epidemiology and End Results Registry 9 data to determine breast cancer incidence among 415,664 white women and 39,887 Black women diagnosed with primary breast cancer at age 19 or older and possible development of a second cancer in the opposite breast.
Results showed that 22,290 (40 percent) developed a second breast cancer, of which 18,142 (four percent) occurred in the opposite breast. Incidence of second primary cancers of the opposite breast was higher among Black women and 15,101 (83.2 percent of second cancers developed in those who were diagnosed with first breast cancer at age 45 or older.
Maktabi joined three other researchers in highlighting their studies during the teleconference.
According to study results, an association has been found between stress and breast cancer aggressiveness.
“We found that after diagnosis, Black and Hispanic breast cancer patients reported higher levels of stress than whites and that stress associated with tumor aggressiveness, said Garth H. Rauscher, Ph.D., associate professor of epidemiology in the division of epidemiology and biostatistics at the School of Public Health, University of Illinois at Chicago.
Rauscher and colleagues studied patient perceptions of fear, anxiety and isolation, together referred to as psychological stress and associations with breast cancer aggressiveness.
The study included 989 breast cancer patients who were recently diagnosed. Of those, 411 were non-Hispanic Black, 937 were non-Hispanic white, and 181 were Hispanic. Results showed that psychosocial stress scores were higher for both Black and Hispanic patients compared to white patients.
“Those who reported higher levels of stress tended to have more aggressive tumors. However, what we don’t know is if we had asked them the same question a year or five years before diagnosis, would we have seen the same association between stress and breast cancer aggressiveness?” Rauscher said in a release.
Depression affected preventive health screenings among Latina breast cancer survivors according to data presented during the conference.
“Depression can make people more inattentive to potential risks to their health and more likely to ignore recommendations to reduce their risk,” said lead researcher Amelie G. Ramirez, professor and director of the Institute for Health Promotion Research at the Cancer Therapy and Research Center at the University of Texas Health Science Center at San Antonio.
Ramirez and colleagues examined the extent of depression among a group of 117 Latina breast cancer survivors to assess the barriers to preventive health screenings for colorectal and ovarian cancer.
“The most important thing we found was that Hispanic breast cancer survivors were more depressed than Hispanics in the general population and that they were not following recommendations to continue other cancer screening behaviors.”
Research also indicated that U.S. immigrants are still less likely to have undergone breast cancer screenings than native U.S. women.
Researchers at Pennsylvania State University believe that lack of access to health insurance and a regular source of health care are important factors related to the lower percentage of mammography screening among U.S. immigrants.
“There is progress, overall, in use of mammography among foreign-born women in the United States, but there is still a lot of work to do to improve their use of recommended breast cancer screening,” said lead researcher Nengliang Yao, a doctoral student in health policy and administration.
October is National Breast Cancer Awareness Month. One in eight women will develop breast cancer in her lifetime. About 182,000 American women developed breast cancer last year alone. It kills nearly 46,000 American women each year. According to the American Cancer Society, breast cancer is the most common form of cancer among American women. Every woman is at risk for it.
Breast cancer is thought of as a woman’s disease, but men can also develop a form it. Each year, over 400 men die from breast cancer.
The incidence of breast cancer has continued to increase at about 2 percent a year, but the death rate has declined. This decrease is believed to be the result of earlier detection and improved treatment. But 2 percent of the autopsies performed in 2003 showed undiagnosed breast cancer. That means a lot more women have breast cancer and don’t know it.
Breast cancer occurs when a group of cells grows out of control and divide more than they should, forming masses called tumors. Some tumors do not spread to other parts of the body, but may interfere with body functions and require removal. These are known as benign tumors. Malignant (or cancerous) tumors invade and destroy normal tissue, then break from the original tumor and migrate to other parts of the body and may form other malignant tumors. Breast cancer can spread through the lymph nodes to the lungs, liver, bone and brain.
Dr. Elizabeth Patterson, a radiologist at the Hospital of the University of Pennsylvania, said cancer is an attempt of abnormal cells to overtake the normal cells and spread. The incidence of breast cancer in African-American women is less than in the general population, she said, but the death rate is higher. According to a National Cancer Institute study, African-American women are 2.2 times more likely to die from breast cancer than their white counterparts. Black women generally have more aggressive breast cancer and have shorter survival times than white women. It’s been estimated that when comparing white and Black women with breast cancer, Black women had between a 70–90 percent increased risk of dying from it than white women, independent of the stage in which the cancer was diagnosed.
Some studies have argued that the difference in breast cancer mortality between Black and white women reflects different standards of care of women who have different incomes. This could be true, but it does not answer the question of why Black women have more aggressive breast cancer than white women, nor does it explain why breast cancer mortality rates have risen faster in young Black women than in young white women.
Breast cancer is the second leading cause of cancer death among African-American women. The incidence for women under 40 was higher among Black women than among whites, but it is increasing in both the young Black and white populations. However, young Black women are getting more breast cancer and dying from it more often than young white women.
Patterson suggested, “There are several reasons (for the disparity). African-American women tend to seek treatment during latter stages of the disease process. Denial is a big problem which allows time for the disease to spread to other parts of the body.”
Many myths keep women from seeking treatment. These include, “Cancer is a death sentence;” “Once surgery takes place and the cancer is exposed to air, it will spread like wildfire,” and many women don’t believe there is a cure. Patterson believes that these myths exist partly because there aren’t any highly visible African-American role models to show that cancer can be cured and that one can resume a normal lifestyle. Studies show that African-American women don’t think of cancer as one of their diseases. Many older women believe the myth there is something wrong with touching their own bodies. There’s also a lack of awareness about the importance of mammograms and a lack of access to the health-care system, said Patterson. The survival rate is very good when breast cancer is detected and treated early, she said. On an encouraging note, she did say that young African-American women are more aware and do perform self-examinations more frequently.
It is not known what causes breast cancer or how to prevent it. It’s known that the risk for developing it is greater in some women whose mother, sister or other close relative has had it. White women are slightly more likely to get breast cancer than are African-American women. But African Americans are more likely to die of this cancer. Although Asian, Hispanic and American Indian women have a lower risk of getting breast cancer, studies show that there has been a big increase in the numbers of these women developing breast cancer.
Women are at risk for breast cancer if they:
· are over age 40 and especially over 50.
· have already had cancer in one breast.
· have close relatives who had breast cancer before age 50 or menopause.
· take menopausal hormone therapy (either estrogen alone or estrogen plus progestin) for five or more years after menopause.
· had their first menstrual period before age 12.
· went through menopause after age 55 or never had children.
· show mostly dense tissue on a mammogram.
· are obese after menopause.
· are physically inactive throughout life.
· have had no children, or who had their first child after age 30.
· have 2 to 5 drinks daily.
Women with one or more of these risk factors should examine their breasts monthly. They should also have a health-care professional examine them regularly.
The most common sign of breast cancer is a lump or thickening that does not go away or change how it feels. Keep in mind that four out of 5 lumps are benign and not cancerous. Other signs to look for are swelling, puckering or dimpling, redness, and soreness of the skin or nipple discharge. The nipple may become drawn into the chest, change shape, bleed or become crusty. Usually, early breast cancers are painless but if you experience pain and tenderness throughout your menstrual cycle, you should tell your physician.
Patterson said treatment of cancer may use a combination of therapies, Patterson said, including radiation, a lumpectomy, a partial, modified or full mastectomy, chemotherapy and hormonal therapy.
Patterson said families should talk about it more and be open about the disease. Every woman should have a baseline mammogram between the ages of 35 and 39 to help detect changes in later years. Between ages 40 and 50, a woman should have one every one to two years. Those over 50 should have a mammogram every year.
Breast cancer is not a death sentence and neither are the treatments, stressed Patterson.
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Women from across Philadelphia will have the opportunity to learn detailed information about breast cancer during the upcoming Sisters For The Cure event.
Hosted by Susan G. Komen for the Cure Philadelphia, the event will be held December 10 from 8:30 a.m. to 2 p.m. at the Philadelphia Marriott Downtown, 1201 Market Street.
Held under the theme, “The Power, The Passion and The Promise To Beat Breast Cancer,” Sisters for the Cure features special presentations, survivor testimonials, breakout sessions and entertainment.
An event highlight includes a short play titled, “No More Secrets” by Kimberly Brown, performed by the Tabernacle International Deliverance Church Drama Ministry, with breast health information by Dr. Donee Patterson, family medicine physician and director of Medical Community Outreach, Albert Einstein Medical Center.
“The play is meant to be informational and also to tell people that it’s important to talk to each other and share family history,” says Patterson.
“What I hope is that what I say will be inspirational to people who have known other people with breast cancer, or have had breast cancer, or are suffering currently. I hope what I am saying will help them be encouraged.
“There are 2.5 million people who are breast cancer survivors. It doesn’t have to be a death sentence, so hopefully we will get that word out,” she added.
Breakout group sessions will delve into topics including breast cancer in young women, the role of the breast navigator, advances in radiation treatment, how the medical oncology home can improve breast cancer care and integrative healthcare.
Other highlights include a keynote address on “The Power and the Passion to Beat Breast Cancer” by Ahmeenah Young, president and CEO, Pennsylvania Convention Center Authority, and the presentation of the Power of the Promise Community Service Award to Jerry J. Jordan, President, Philadelphia Federation of Teachers. Jordan will be recognized for the federation’s work in raising funds for Komen.
Walk-in registrations will not be accepted at the event.
For information visit www.komenphiladelphia.org/sfc.
Praise is the Cure to educate, celebrate
Breast cancer awareness in the African-American community will be the focus of the seventh annual “Praise is the Cure Week of Hope, Health and Healing.”
The event, held Sept. 26 through Oct. 6, focuses on spreading awareness of breast cancer and uplifting African-American breast cancer patients and survivors.
Praise is the Cure is held by the George E. Thorne Development Center and Anita T. Conner, a 14-year breast cancer survivor and Philadelphia-based accountant.
“This is a passion of mine, because we need to get the word out about breast health. The most common cancer among African-American women is breast cancer — and we die of it more than any other ethnic group,” said Conner.
“Even though the percentages are getting better, we still die the most.”
Throughout the years, Praise is the Cure has evolved from a one-day affair where breast cancer information was distributed to 10 area churches, to a week-long event that now encompasses a children’s festival, a day of activities, and the participation of about 100 churches.
The event kicks off on Wednesday, Sept. 26 at 4:30 p.m. at the Abington YMCA, 1073 Old York Road, with the Maddie Movement, Children’s Festival. A second festival will be held Oct. 3 at 4:30 p.m. at Columbia-North YMCA, 1400 N. Broad St. The book “Mommy Has Breast Cancer But She is OK” will be highlighted during the festivals. The book was written by Conner’s daughter, Kerri Conner-Matchett, with the purpose of inspiring women with breast cancer and their young children. Conner-Matchett was also diagnosed with breast cancer.
“The Children’s Festival has become an important component. We also find that it’s been a great venue to teach parents how to talk to their children about difficult things,” Conner said of the festival.
The celebration continues Sept. 30 with Praise Sunday at 100 churches and worship centers throughout the Delaware Valley. During Praise Sunday, participating houses of faith will celebrate breast cancer survivors and raise awareness about breast health through presentations and the dissemination of lifesaving information to their congregations. Conner says they expect to distribute breast health literature to about 15,000 people on Praise Sunday.
“What I’m finding is, you can’t share this information enough. Every year we try to put out a resource tool, but you just can’t get the message out enough. We just want to encourage families to take charge of themselves and their bodies,” Conner added.
The week concludes Oct. 6 with a packed day of activities at Mt. Airy Church of God in Christ, 6401 Ogontz Ave. A community health fair and wellness workshops will be held from 10 a.m. to 4 p.m. The workshops will be led by representatives from Fox Chase Cancer Center and Living Beyond Breast Cancer. Oncology nurse Connie Sumner will also give a presentation.
Conner is hoping that the information provided will help to dispel myths that surround breast cancer.
Mammograms will be offered during the community health fair, however, participants must register in advance for the service.
A men-only forum titled “Real Men Wear Pink – Taking Care of Others and Yourself” will be held at 3 p.m. The forum, sponsored by Kappa Alpha Psi Fraternity, Inc. features a panel discussion with oral surgeon Dr. Franklyn Scott; gastroenterologist Dr. Steven Blake; health columnist and lecturer Glenn Ellis and radio personality Doug Henderson.
A patients’ and survivors’ pamper party will be held at 4 p.m., where about 200 women will be given spa treatments. A “Sister Talk” session led by Lorina Marshal Blake, president of the Independence Blue Cross Foundation, will be held during the pamper party.
The event rounds out with a gospel concert at 6:30 p.m. featuring Hezekiah Walker and LFC and The Brockington Ensemble.
Since its inception, Praise Is the Cure has reached more than 100,000 Philadelphia-area residents and has raised $200,000 to support year-round program efforts.
Registration is required for certain activities. To register, call (215) 635-1025 or visit www.praiseisthecure.org.
Every 12 minutes a woman in America dies of breast cancer. Breast cancer is the most common malignancy.
Younger Black women who get breast cancer are more likely than other women who have breast cancer to have a particularly aggressive and lethal form of the disease. Most findings suggest that biology may help explain why breast cancer is deadlier in Black women younger than 55 than it is in white women in the same age group. Other studies have blamed inadequate screening rates.
In a study published in the Journal of the American Medical Association, researchers questioned 408 women with a family history of breast or ovarian cancer. Only 16 of the 71 Blacks studied — about 22 percent — received genetic counseling, compared with 184 of the 310 white women, or about 60 percent.
Since 1990, the average annual breast cancer death rate for younger Black women in the United States has been 15.4 deaths per a 100,000 population, versus 9.3 per 100,000 for younger white women.
The gap might reflect fears of discrimination and a general distrust of the medical establishment, while others said some Blacks might be reluctant to talk about cancer.
Dr. Funmi Olopade, a breast cancer researcher at the University of Chicago who co-wrote an accompanying editorial, said Black women tend to underestimate their risk of breast cancer and lack awareness about BRCA flaws.
The flaws cause 5 percent to 10 percent of the more than 1 million cases of breast cancer diagnosed worldwide and 200,000 cases nationwide each year.
Statically these statements are true, but it does not answer the question as to why Black women have more aggressive breast cancer than white women, nor does it answer the question of why breast cancer mortality rates have risen faster in young Black women than in young white women.
If you have no history of breast cancer, there are steps you can take to keep your risk low. If you’ve been diagnosed, there are things you can do with treatments to reduce the risk of the cancer coming back or developing a new cancer. When living with an advanced-stage breast cancer, you want to slow the cancer’s growth.
More research is needed to learn how factors in the environments outside and inside your body that affect your health and raise your risk of developing breast cancer. The environment inside your body includes the genes you get from your mother and father, hormone levels, body fat and illnesses. Your environment outside your body includes not only air, water, food, but also everything you come into contact with everyday.
Nearly five Black women die needlessly per day from breast cancer in the United States — a total of 1,722 deaths annually — according to a study released at the Avon Foundation Breast Cancer Forum and simultaneously published in Cancer Epidemiology.
The 2012 Racial Disparity in Breast Cancer Mortality Study found that 21 of the 25 largest U.S. cities have a Black-white disparity in breast cancer mortality, 13 of which are statistically significant.
The study, conducted by Sinai Urban Health Institute and funded by the Avon Foundation for Women, is the first national study to examine the racial disparity in breast cancer mortality at the city level in the United States. The researchers analyzed breast cancer deaths reported between 2005 and 2007 against seven societal (ecological) risk factors, including race, poverty level and racial residential segregation. The authors conclude that societal issues such as poverty and racial inequities cause most of the disparity and genetic factors comprise a very small portion of the disparity.
“Our research shows societal factors — not genetics — are largely to blame for the racial disparity in breast cancer mortality nationwide,” said Steve Whitman, Ph.D., director of Sinai Urban Health Institute and the study’s lead author.
“When a woman believes genetics causes her disease, it breeds a sense of hopelessness and fear. Our study proves that Black women can play an active role in reducing their risk of dying from breast cancer by getting screened and following through with treatment. But it’s incumbent on society to improve access to quality mammography and to ensure that breast cancer treatment is available to all women, including the under- and uninsured.”
The Black-white disparity reflects the difference between the non-Hispanic white and non-Hispanic Black breast cancer mortality rates in the cities analyzed.
In some cities, such as Detroit, where the white and Black breast cancer mortality rates are both high, practically no disparity exists. If the disparity ratio is more than one, then the Black rate is higher; if the ratio is less than one, then the white rate is higher. The number of excess deaths is a function of two factors: the size of the disparity and the size of the population of the city. Thus, although New York City has a very small disparity (1.24), the number of excess deaths from this disparity is 70 because of the large population size. Chicago is much smaller than New York City, but its disparity (1.62) is much larger, resulting in a similar number of excess deaths (76).
The study found that 13 cities have a statistically significant disparity (disparity greater than 1): (in order of population size) New York City, Los Angeles, Chicago, Houston, Philadelphia, San Diego, Dallas, Jacksonville, Columbus, Memphis, Seattle, Boston and Denver.
The report indicates that more than one Black woman a week dies needlessly in both Chicago and New York because of the racial disparity.
Following a 2007 Sinai Urban Health Institute study that produced alarming data on the racial disparity in Chicago’s breast cancer mortality, the Avon Foundation funded the establishment of the Metropolitan Chicago Breast Cancer Task Force to address the disparity. The Task Force issued recommendations to improve screening quality and reduce disparities in Chicago that can be applied to other cities.
The Task Force gave four recommendations to prevent cancer deaths including ensuring all women understand the importance of breast health screening; ensure all women have access to early detection programs and screening; improve the quality of breast screenings for all women; and ensure all women who need treatment receive high-quality treatment in a timely manner and are completing the recommended therapy.
Black women are less likely to receive a newer surgical procedure for breast cancer, according to a new study.
The study, led by Dr. Dalliah Mashon Black, assistant professor of surgery in the department of surgical oncology at The University of Texas MD Anderson Cancer Center in Houston, found that Black women were less likely to receive a sentinel lymph node (SLN) biopsy.
“It used to be that we remove all the lymph nodes under the arm to determine whether the breast cancer had spread but then this new technique, the sentinel lymph node biopsy was developed, and it was dissimilated throughout the country in the mid-2000s,” Black said.
“So we looked at how this newer technique was being implemented in Black women versus white women with breast cancer.”
“The sentinel lymph node biopsy is a more minimally invasive surgery, so it has fewer complications compared to stripping out all the lymph nodes under the arm - and it has a less complication of arm swelling. Patients can really have problems with that larger surgery, so it is important for patients to try to get the newer sentinel lymph node biopsy,” she added.
Using data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database, Black and her colleagues evaluated whether there was a difference in the utilization of SLN biopsy in Black patients compared to white patients, and whether this difference impacted the risk for lymphedema, which is a complication characterized by arm swelling that may occur after auxiliary surgery.
The researchers assessed data from 31,274 women aged 66 or older, including 1,767 Black women, 27,856 white women and 1,651 women of other or unknown race.
“Black women were 12 percent less likely to receive a SNL biopsy compared to white women,” said Black, who presented the data during the CTRC-AACR San Antonio Breast Cancer Symposium held on the week of December 4.
Hosted by the Cancer Therapy and Research Center at UT Health Science Center San Antonio and the Philadelphia-based American Association for Cancer Research, the symposium draws an audience of academic and private researchers and physicians for more than 90 countries.
The study indicated that 62 percent of black women underwent SLN biopsy compared with 74 percent of white women. The use of SLN biopsy increased each year for all patients, but disparities persisted through 2007.
The researchers found that Black women who did not undergo an SLN had an increased risk of arm swelling.
“The disparity in SLN translated to a worse clinical outcome for those Black patients,” Black said.
Black women remained significantly less likely to receive SLN biopsy compared with white women despite adjustment for tumor size, patient sociodemographics and type of breast surgery. Furthermore, ALND was associated with twice the risk for lymphedema in black patients compared with patients treated with SLN biopsy.
Black says the data highlights the need for improving national implementation of changes in practice standards and for understanding how physician cancer teams incorporate recommendations in different patient populations.
“Disparities can affect a patient’s survival but disparities can also affect a patient’s quality of life,” Black said.
“So if patients are having an unnecessary, bigger surgery that may affect that patient’s quality of life and so as healthcare providers we need to have more education about how we are discussing surgical options with minority patients. We need to be aware that this disparity exists and it is affecting clinical outcomes, specifically lymphedema. We still have work to do to narrow this disparity gap.”
Black and colleagues hope to update this study with data from the 2010 SEER-Medicare database to evaluate whether improvements have been made since 2007.