Chicago leads the United States in reducing the disparity in breast cancer deaths for black women, and the city’s efforts to eliminate this health inequity are being touted as a model for other cities in the United States.
Black women nationwide die of breast cancer at much higher rates than white women, but in Chicago the difference in these rates decreased an average of 3.1 percent a year from 2006 to 2013, according to a study conducted by the Metropolitan Chicago Breast Cancer Task Force. This reduction took place amid comprehensive, city-wide public health initiatives by the task force and others to address the disparity, “and shows promise as a model for other cities with high health outcome disparities,” according to the report.
Breast cancer mortality rates for both black and white women in Chicago declined during the 2006-2013 period, but the rates for black women decreased more (by 13.9 percent) compared to white women (7.7 percent). Thanks to that improvement, the overall disparity in mortality rates for Chicago women went from being above the average in the United States to being below the U.S. average. In the other nine cities studied, the disparity rate either increased or remained the same.
The study findings were published in the June 2017 issue of the journal Cancer Causes & Control.
Task force found uneven access to breast health resources
For the study, researchers compared Centers for Disease Control and Prevention data on breast cancer mortality rates in the ten cities with the highest black populations during the six-year time frames before and after the task force began operations in 2008. Based at Rush University Medical Center, the task force operates as an independent not for profit organization in close collaboration with Rush faculty and health care providers.
Its initial effort was to collect and assess data on breast cancer screening and treatment from more than 60 Chicago-area facilities and hospitals. “We had a very systematic approach for assessing breast health systems and found a lot of variation in regard to how resources are readily available to women in different areas,” said task force executive director Anne Marie Murphy, PhD.
“Mammography resources are unevenly divided. Black women were less likely to have their mammograms read by a breast imaging specialist. They are more likely to have their mammograms read by a generalist.”
City commits $700,000 to help increase access to breast health care
The collaboration continued with more rigorous and standardized quality assessment, mapping and reducing inequities in resources, improving quality, and establishing patient navigation systems to overcome barriers to care for women in medically underserved neighborhoods.
“For black women in Chicago, a breast cancer diagnosis in 2003 meant you were 68 percent more likely to die from the disease than a white woman,” said the study’s lead author, Dominique Sighoko, PharmD, MPH, PhD, an epidemiologist with the task force. “That disparity rate has been halved.
“While any race-based gap in cancer survival rates is unacceptable, we remain committed to eliminating them, I am proud that Chicago is showing how that goal can be reached: shared commitment and resources.”
To further reduce this difference, the Chicago Department of Public Health has committed $700,000 to support efforts by the task force, Rush University Medical Center and other health care providers to increase access to breast health services for women in underserved communities.
‘Health care leaders cannot blame women or their biology’
The study authors also suggest the nationwide findings offer further proof that structural racism far outweighs biological factors in surviving breast cancer. Public health data shows that there was no racial disparity in breast cancer mortality rates 30 years ago, but survival rates for white women began to rise steadily in the 1990s when better screening and treatment became available
“Seeing 15 years of outcomes data from across the country tells us what should be obvious: Health care leaders cannot blame women or their biology,” said Dr. David Ansell, co-founder of the task force and senior vice president of health equity at Rush.
“Women’s genes haven’t changed in 30 years. If the rates at which African-American women die are substantially higher, it suggests the cause is racism, not race.”
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