Komen NEO Statement on Racial Disparities in Healthcare

Friends,

As we continue to navigate the uncertainty of the COVID-19 pandemic, we are faced with the tragic killing of George Floyd that has sparked a significant and powerful outcry against racial inequity in our country.  As we consider and reflect on the messages we hear each day, Komen Northeast Ohio recognizes that, in our work, we see the evidence of healthcare disparities in breast cancer treatment outcomes every day.

Overall, White women are slightly more likely to get breast cancer, but Black women are more likely to die from the disease.  In fact, breast cancer mortality (death) is roughly 40 percent higher in Black women than in White women.  Why?  Like many issues of the day, there are multiple reasons for this disparity.

Some of them lie in tumor biology and genetic differences between Black women and White women.

  • Black women are more often diagnosed with more aggressive forms of breast cancer, including triple negative.
  • Black women are more likely to be diagnosed at a younger age.
  • Black women who are diagnosed with breast cancer and have gone through genetic testing are more likely to have BRCA1/2 mutations compared to other populations.

However, the main reason for these disparities in outcomes lies in patterns of care and ACCESS to care issues that have nothing to do with biological make up.

  • Black women experience differences in the quality of mammography, issues with appropriate follow-up care or delays in diagnosis, treatment delays and misuse (or underuse) of treatment to Black populations.
  • One study found that places that served mostly minority women were more likely to be public institutions, less likely to have digital mammography, and less likely to have dedicated breast imaging specialists reading the films.  All of these factors can lead to poor quality care.
  • Many studies show the time from diagnosis to treatment for Black women was longer than for White women.  One study showed the average time from diagnosis to treatment was nearly 30 days for Blacks versus about 22 days for Whites.
  • Once treatment does start, studies have shown Black women often do not receive the recommended standard of care.
  • In comparison to White women, studies have found:
    • Lower rates of radiation therapy after lumpectomy;
    • Lower doses of chemotherapy; and
    • Lower adherence to tamoxifen.
  • These issues may have been due to physician beliefs, or cost may be a factor (as is sometimes the case with tamoxifen use).
  • In another study Black women were more likely to stop treatment early or have treatment delays than White women.  This was not due to treatment side effects, but to possible barriers, such as:
    • Difficulty in arranging for child care;
    • Missing work; and
    • Inability to afford transportation to treatment.

What we are seeing are gaps in our healthcare system that prohibit an equal standard of care for breast cancer patients.  Obviously, some of these factors are outside the scope of the disease itself, but are public health concerns related to the social determinants of health (e.g. affordable and accessible transportation, child care, etc.).  In addition, just because an individual has access to health insurance, it does not mean he/she will receive the highest standard of care or have “equal” health outcomes to other populations.

Ultimately, we want you to know what we are doing about this.  Our job is to continue to listen to and learn from our constituents in Northeast Ohio to understand the issues they face along their journey and battle with breast cancer. Komen NEO is tackling these issues by:

  • Using advocacy to increase/expand insurance coverage to those who need it most, but, keeping in mind the social determinants of health, we know coverage does not ensure patients have access and will be free from racial bias in treatment options.
  • Patient education/physician communication – we are launching a virtual training series for providers to bring awareness and insight into how their actions and potential unconscious bias affect healthcare outcomes.
  • Patient navigation and transportation assistance.
  • Systems change – for example, inner-city health facilities need well-maintained equipment and the mammography technologists at these facilities should have access to continuing education. We also need more mobile mammography units to serve areas where health facilities are not accessible.
  • Precision medicine for all.

We have a long way to go to achieving health equity for all in our community, but with your continued support of our mission and the willingness of our staff, board and advocates to listen and learn from our constituents – we remain committed to learning how best to the meet the needs of all breast cancer patients in Northeast Ohio.

In partnership,

 

 

Sean Shacklett
Executive Director

*Adapted from the 2016 Susan G. Komen document “A Perfect Storm.” – To learn more, please click here for the full manuscript.