Expert Commentary: Dr. David Ansell, M.D., MPH - June 2, 2009

I am the President of the Board of the Metropolitan Chicago Breast Cancer Task Force (www.chicagobreastcancer.org) , a not for profit group that has at its mission the elimination of the racial disparity in breast cancer mortality in the Chicago area. I am also the Chief Medical Officer at Rush University Medical Center in Chicago.   Our task force put out a report in 2007 which showed that black women in Chicago had a mortality rate of breast cancer which was significantly higher than white women, and that this gap had grown since 1980 when the death rates were equivalent. By 2005 black women were over two times more likely to die of breast cancer than white women in Chicago. Much of this we attribute to 3 major interconnected problems. While the black breast cancer mortality rate has not budged in over 20 years, white women, on the other hand have experienced about a 50% reduction in the breast cancer mortality rate during the same period.

The taskforce explored three hypotheses to explain this disparity. The first one was that black women did not have access to mammography and weren’t getting mammogram screenings at the same rate as white women. Second, that when they did get mammograms the mammograms were of lower quality. As a result, black women were less likely to get a cancer detected at a screening, they were less likely to get abnormal results given to them face to face, and they were less likely to have their mammogram read by a breast specialist all factors that can lead to late stage of cancer at presentation.  And third, once a black woman got treatment she was less likely to actually complete treatment. Much of the work of the task force has corroborated these hypotheses and has led us to the conclusion that we cannot fix just one part of the system but need to address all the deficiencies within our Chicagoland health care system that contribute to this inequity.

One reason we suspect our health care system is the culprit in this disparity is that black: white breast cancer mortality disparity in Chicago is the largest ever reported in the country. The black: white mortality disparity in Chicago is three times that of the national disparity, and seven times that of New York City. There’s something uniquely bad going on in Chicago. We think this has to do with the organization of care among other variables, and we think it’s something we can fix.
 
Chicago is known as one of the most racially segregated cities in the US. One legacy of this racial segregation in Chicago is that that white women and black women tend to get care at different institutions. And thus the quality of care may actually be different.

Another taskforce finding was that there was not enough capacity in Chicago to do all the mammograms that one would need to do if every woman between the ages of 40 and 69 got an annual screening mammogram.  So there’s a lot of inter-locking, connected issues that have contributed to the disparity. And the outcome of this in Chicago is that 100 black women die every year unnecessarily, just because they don’t have the same level of breast care as white women.

We know it does not need to be this way. We have actually looked at the outcomes if black women and white women get high quality screening mammograms and breast cancer diagnosis at the same high performing facilities here in Chicago.  Preliminary data shows that wherever high quality mammography is provided, there’s really no difference between blacks and whites in breast cancer outcomes.

Work is going on in Chicago to address this glaring racial disparity in breast cancer mortality. Over sixty area hospitals have joined the Chicago Breast Cancer Quality Consortium, a partnership between the taskforce and the Illinois Hospital Association that will be measuring and improving the quality of breast cancer screening, diagnosis and treatment at Chicago area institutions.  These differences in outcomes do not have to be. But it will take all of us to improve the outcomes- healthcare facilities, health professionals and the community.


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