Breast cancer deadlier for blacks

Why? Report blames racism, says mammograms, care may be inferior

African-American women in Chicago are much more likely than white women to die of breast cancer, and the racial gap is widening, according to a new study that calls the disparity "morally wrong, medically unacceptable and reversible."

Just 10 years ago, black and white women in Chicago died at the same rate from breast cancer. But the most recent figures available, for 2003, show the mortality rate among black women was 73 percent higher, researchers at Mount Sinai Hospital's Urban Health Institute report in a study being released today. Nationwide, the gap was about half that -- 37 percent.

The disparity in death rates appears to be the result of racism, "and it appears to be institutionalized," said Alan Channing, chief executive of Sinai Health System.

In Chicago, white women are diagnosed with breast cancer at a rate 15 percent higher than the rate in black women.

So why are more blacks dying from the disease?

One explanation that's been offered is that African-American women might be genetically predisposed to getting more aggressive forms of breast cancer. The Mount Sinai researchers -- who examined data from the state's cancer registry, public health department and Behavioral Risk Factor Surveillance System -- reject that notion. They offer three possible alternative explanations:

•    Mammograms done on African Americans "might be of less than optimal quality," according to the researchers, who hope to publish their findings in a medical journal. Their study notes that mammogram centers typically spot five to seven cancers for every 1,000 mammograms. But they found that, at one Chicago center serving low-income women, only 2.4 cancers were spotted for every 1,000 mammograms. The researchers did not identify the center.

Lillie Bell, who is African American and lives in Chicago, says she underwent mammograms every year, and every year was told she was "completely OK." Then, in 1999, Bell was diagnosed with relatively advanced, Stage 3 breast cancer. Now in remission after surgery, radiation and chemotherapy, "I'm doing fine," Bell said. But she thinks her cancer "should have been detected earlier."

The researchers concede that such anecdotal evidence doesn't prove blacks are getting inferior mammograms. In fact, the lone study they could find on the subject concluded that the varying quality of mammogram services "does not appear to be race-linked."

•    In surveys of Chicago women over 40, the percentage of blacks who say they have had a mammogram in the last two years equals that of whites. But researchers suspect that some women might say they've had a mammogram even when they haven't because they figure they should have. Previous studies found poor and black women over-report mammogram rates by up to 30 percent.

•    Once breast cancer is diagnosed, blacks might receive delayed, or less-effective, treatment than whites.

To prove that, said Joseph Harrington, assistant commissioner of the Chicago Public Health Department, more research is needed. "At this point," he said, "we can only speculate."

The Mount Sinai researchers proposed that Chicago hospitals and mammogram centers collect and share data on mammogram quality. A new citywide task force will examine the problem.

jritter@suntimes.com