Barriers to Treatment Blamed for High Rates

Much of the District's high rate of breast cancer can be blamed on a confusing, disjointed system of screening and treatment, beset by lengthy appointment delays and inconsistent coverage, according to a report by a prominent nonprofit group.

Cultural beliefs and health illiteracy, especially among minority and low-income women, exacerbate the problems, the report says. Among more than half a dozen recommendations, it proposes increased funding for programs to connect with women in different ways -- faith-based outreach focusing specifically on breast cancer and trained "navigators" who help patients through medical appointments and procedures.

The city is one of eight "most affected" communities profiled by Susan G. Komen for the Cure as it launched a nationwide campaign this week to narrow disparities and eliminate gaps in breast cancer care. Survivors and activists from 34 states lobbied congressional offices for more federal dollars and held a "close the gap" rally on the lawn of the Capitol, urging the country's leaders to make breast cancer a priority.

By yesterday, the issues were locally focused, with a panel discussion at Providence Hospital addressing the District's needs -- and promise. Over the next several years, the city will direct $20 million to a coalition of cancer groups to improve and expand prevention, diagnostic and treatment programs. "This is an opportune time for a proactive approach on breast cancer issues," Komen's summary on the District notes.

The rates of breast cancer incidence and death are significantly higher in Washington than for the nation as a whole -- the mortality rate of 33.7 per 100,000 people is nearly a third higher -- and the report's comparisons with individual state figures make D.C. statistics look even worse.

More telling would be comparisons with other municipalities, but the report does not provide consistent figures, much less jurisdictions of similar size or composition, to allow that. Of the communities highlighted, four are rural counties in the South, West Virginia and Illinois. The others are Chicago, Harlem in New York and Wayne County, Mich., which includes Detroit.

The District's mortality rate from breast cancer exceeds that of Wayne County (30.9 per 100,000) but is sharply lower than that of McDowell County, W.V. (45.7). Its number of breast cancer diagnoses (147.8 per 100,000) tops New York's (133.1, with no breakdown for Harlem) but is far below the incidence in Edgecombe County, N.C. (185.3).

Yet common to all of the communities, according to the report, are economic barriers that restrict access to care: too few providers, including oncologists and radiologists; and a lack of awareness of available services, even among physicians.

In the District, women interviewed during Komen's research discussed lower-income African Americans' distrust of the health-care system. They said some black women do not readily seek medical attention because of their partners' belief that breast cancer is a "scourge" and that mastectomies would render a woman "unwhole."

Immigrants often are discouraged from screening or care because of legal status or language difficulties, the report says. Undocumented women can get a mammogram through Project Wish, as the District's Breast and Cervical Cancer Early Detection Program is known, but not chemotherapy or radiation if a tumor is detected.

"Advocates should consider a breast cancer mortality reduction package," the report recommends, and should, among other steps, expand Project Wish to reach more women and offer more of them treatment.

"It's not enough to have a test, to have something found on a test. You need to be treated for that, whatever it is," Harold Freeman, former director of the National Cancer Institute's Center to Reduce Cancer Health Disparities, told the Providence Hospital forum.

In Harlem, women's five-year survival rates following diagnosis nearly doubled after Freeman pioneered patient navigators. Several District hospitals and organizations have since begun their own programs, with five local groups participating in a federally funded project run by the George Washington Cancer Institute to assess how quickly women receive care when they have a knowledgeable guide by their side.

"If we don't have navigators, women will continue to die because their cancer was found too late," said Larisa Caicedo, executive director of Nueva Vida, a support network for Latinas with cancer.

Susan G. Komen for the Cure, founded 25 years ago, works nationally and internationally on breast cancer education, research and support.