Chicago Leads Nation in Reducing Racial Disparity in Breast Cancer Deaths
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. But roughly a decade earlier, there was no such disparity.
Public concern over the growing trend led to the creation of the Metropolitan Chicago Breast Cancer Task Force in 2008.
Anne Marie Murphy, executive director of the task force, said the growth of the mortality disparity was “alarming.” Community leaders, advocates, health care providers and breast cancer survivors who make up the task force have been working ever since to eliminate “inequities in prevention, screening, diagnosis, treatment and survivorship of all women,” according to its mission statement.
After nine years, a new study finds the task force is having an impact: An analysis of data collected from 2006-2013 shows that African-American women diagnosed with breast cancer were 39 percent more likely to die from the disease than their white counterparts.
“Now that 68 percent has come down to 39 percent. That’s a huge difference,” said Murphy. “It’s a large drop and we’re delighted about that. Obviously, we haven’t gotten to zero like we’d like to get to, but the needle is finally moving in the right direction.”
The study compared nationwide breast cancer mortality rates with those in Chicago and nine other U.S. cities with populations of at least 500,000 and high numbers of African-American residents. Researchers compared figures for each city over two time periods: 1999-2005 and 2006-2013.
From 1999-2005, the mortality disparity increased annually by 3.9 percent in Chicago, according to the study. But the trend was reversed from 2006-2013, when it decreased annually by 3.1 percent.
“Chicago’s collaborative efforts have shown that health disparities are not inevitable,” Murphy said. “They are not immutable. They can be overcome and health equity can be achieved.”
“The changes we’ve seen are a reflection of the city’s commitment to addressing health disparity,” said Chicago Department of Public Health Commissioner Dr. Julie Morita. “I think anytime we embark on a new effort to address health disparities we are concerned whether or not they’ll be successful, which is why we’re committed to doing studies like this one. ... It’s critically important to monitor initiatives to make sure they’re making a difference.”
Mortality rates for breast cancer dropped nationally between 2006 and 2013, with greater declines for white women in all cities – except Chicago, where black women saw a decline of 13.8 percent, compared to 7.7 percent for white women.
“Chicago leads the nation in reducing breast cancer deaths for African-American women,” Murphy said “The task force is unique in that it took a comprehensive approach to this disparity. We really felt strongly one needed to do a comprehensive assessment and then take an evidence-based approach on the front end and gathered a lot data as to where the challenges are in Chicago.”
Chicago’s ‘Comprehensive’ Approach
The task force began its first project, the Chicago Breast Cancer Quality Consortium, with the mission of improving “patient safety and the quality of breast cancer screening and treatment by sharing data on quality measures for breast cancer screening and treatment and developing quality improvement projects based on analysis of this data.”
Based on the assessment of data collected from about 60 Chicago-area facilities and hospitals, the task force identified areas that could be improved within the health care delivery system, from diagnosis to treatment.
It found a wide variation in the quality of mammograms. “The notion that a mammogram is a mammogram is a mammogram is not true,” Murphy said. “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.”
In addition, the task force found a “fractured” health care system. “Women on the South Side have limited access to service facilities. They don’t have a good pathway for comprehensive care,” Murphy said.
“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,” she added. “For instance, if you’re affluent in Chicago, you have a 40-percent chance of being proximal (within a mile) to a breast imaging center of excellence. If you’re poor, there’s a 1 percent chance of being proximal to a breast imaging center of excellence.”
“Chicago leads the nation in reducing breast cancer deaths for African-American women.”
–Anne Marie Murphy
In its analysis, the task force also discovered that not all facilities have the ability to follow up with their patients. “A lot of safety net facilities don’t have a lot of phones, so they don’t have the funding for navigators to follow up with their patients to get them back to care,” Murphy said. “Those reminders and follow ups really matter.”
That need led to the development of the task force’s Beyond October and Extra Help, Extra Care navigation programs. Navigators help women schedule mammograms, remind them of upcoming appointments, help interpret results and help coordinate treatment if they’re diagnosed with cancer.
“We help women navigate the system because it’s often complicated,” Murphy said.
Through the Beyond October program, navigators help 1,500 women a year and reach 12,000 through outreach and educational programming, according to Murphy. (Women can fill out an application online to qualify for free mammogram screenings through the program.)
About 200 women are helped each year through the task force’s Extra Help, Extra Care program for those who receive abnormal mammogram results at a partnering facility or hospital.
“We’ve made $700,000 available to continue this type of work for free in African-American communities and making sure our navigation services are available if women have abnormal mammograms. It’s not enough to know you have cancer. It’s important for them to get the cure that they need,” Morita said. “We are funding a number of groups and the Metropolitan Chicago Breast Cancer Task Force is one of them.”
Other interventions initiated by the task force include educating the public about the importance of breast cancer screenings, training technologists how to properly take and read mammograms, and conducting on-site assessments of facilities to close any gaps in diagnosis or treatment.
“We’ve done a lot of these interventions. Some have been very successful,” Murphy said. “We think it’s a wonderful model for other locations because it’s something that definitely can be replicated.”
Note: This story was originally published July 21.
Follow Kristen Thometz on Twitter: @kristenthometz
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