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Why cancer kills more African Americans

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Despite decreasing cancer deaths, cancer still kills more African American women than White women. And prostate cancer affects twice as many African American men as White men. These are among the facts presented recently by panel of experts at a Zócalo Public Square event titled, “Why is Cancer Killing More African Americans?”

Death rates from all cancers combined decreased from 1999 to 2008, among most racial and ethnic groups, according to the 2012 Annual Report to the Nation on the Status of Cancer. While more White women are diagnosed with cancer, they have a higher survival rate than Black women. The panel of experts met to discuss the underlying causes of these disparities and what can be done to improve the number of Black cancer survivors.

“Tell me your ZIP code, and I can tell you your life expectancy, someone once told me,” said Daniel Weintraub, a public health policy reporter and editor of HealthyCal.org, an organization that informs Californians about public and community health issues.

Weintraub added that while White women are more likely to get breast cancer, African Americans are 40 percent more likely to die from it and less likely to be diagnosed early. Weintraub goes on to note that, in fact, for all cancers in California African Americans have both the highest incidence and the highest mortality rates.

However, researchers say there is not a single factor they can point a finger at and say, “there, that’s the reason for disparities.” They do know that disparities are linked to “social, behavioral, and economic factors such as persistent inequalities in access to care, language barriers, unhealthy environments, and racial discrimination,” as stated in Cancer Disparities: A Chartbook from the American Cancer Society Cancer Action Network” that addresses disparities through legislation. The consequences of these disparities lead to late diagnosis and reduced survival rates.

Leticia Marquez-Magana, Ph.D., a biologist at the Health Equity Institute for Research, Practice, and Policy at San Francisco State University, said: “African Americans die the most from 12 of the 13 cancers. I think what often gets in the way of our care is having to start the conversation with someone new every time we visit the doctor. Or even if you’re seeing your own doctor, they don’t remember what you discussed during your last visit.

“Our current medical model isn’t working. We’re spending more money on healthcare and our outcomes are worse than countries that spend less. I recently returned from Cuba and there every neighborhood, of roughly 1,500 residents, has a clinic and its doctor lives in that neighborhood. The doctors get to know their patients. They may say, ‘your daughter hasn’t come in for her pap smear. Let’s go talk to her about coming in.’”

Marquez-Magana continued: “We need a bigger healthcare workforce, but right now the medical college admissions test is eliminating candidates, especially minorities, who are sorely needed to study and eliminate these cancer disparities. We need to train them to become the researchers of the future, because African American oncologists only make up 2 percent of the profession. If more enter this field, no doubt, this will increase the number serving in their communities,” said Marquez-Magana.

As healthcare cost rise, only a small percent of funding is funneled to prevention programs, according to a report by the Prevention Institute titled, “The Imperative of Reducing Health Disparities Through Prevention: Challenges, Implications, and Opportunities.”

“ObamaCare is focused on prevention and provides access to insurance, although I’m not sure that’ll translate into access to care,” said Weintraub.

Another cause of the disparities is social inequities which hinder access. Marquez-Magana said Whites earn more than Blacks, have better insurance and can choose a doctor who performs these types of surgeries every day as opposed to a doctor who only does the procedure once every two months.

Whether it’s bias, discrimination or a lack of compliance, some doctors view disparity differently. Often the patient becomes their own worst enemy.

“Two people can have the same exact cancer, one may be White and the other Black, and they’re going to get two different treatments. The standard of care is given to the White patient, because the doctor believes this person will adhere to the stricter more rigorous treatment; whereas, medical personnel think a Black patient will be less compliant. And the survival or outcomes are different. These treatment disparities shouldn’t exist,” said Marquez-Magana. “Offer the same treatment to both and let the Black patient decide whether they’ll comply or not,” she added.

Researchers fear that the reduction in cancer deaths will be reversed due to the obesity problem and lack of physical activity compared to decades ago.

“I’m a scientist, but I’m the most critical person when it comes to scientists and their studies,” said Mignonne Guy, Ph.D. an assistant research scientist at the University of Arizona Cancer Center. “We don’t know the clear link between cancer and diet. And don’t take this the wrong way. Of course diet and exercise are important, but, I see a more direct preventive measure we can take to improve our health, which we aren’t taking. For example, cervical cancer is preventable, but women won’t take the human papilloma virus (HPV) screening test. And since cancer is an aggressive biological disease, we need to be proactive when it comes to our health. That’s why regular screenings are important.”

“Another area African Americans need to participate in are trial studies,” said Guy. “Not enough research is being done on the health of African Americans, men especially. There’s a huge gap in the need for research. As scientists, we should know more than we do. Community members must become more involved and proactive to change this.”

“Black men are disappearing from the face of the earth; their health is so bad. One way to fix this is to take part in clinical trials. I know clinicians may feel guilty about the Tuskegee syphilis experiment and won’t ask African Americans to participate, but we have to be in studies and currently we’re not represented at all.”

The emphasis in today’s medical arena is focused on swiftly finding medicines and advanced technology to treat people once they become sick. But if that same pace, energy and drive is directed at prevention, improving access to care and improving all patients’ mortality rates a new healthy model that saves both lives and costs might emerge.

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