National Edition

Closing the gap: Why are more black women dying of breast cancer?

Published: Wednesday, March 26 2014 9:55 a.m. MDT

Breast Cancer survivors hold a giant American flag during pre-game ceremonies for Breast Cancer Awareness month before an NFL football game between the Jacksonville Jaguars and the San Diego Chargers in Jacksonville, Fla., Sunday, Oct. 20, 2013.

John Raoux, Associated Press

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Tiffany Jones was 29 years old when she found a small red bump on her right breast. It looked like an insect bite, but it didn't go away. When she went to see her doctor, she asked for a biopsy. He insisted that it wasn't necessary, but he did it anyway to give her peace of mind. An hour later, he called her while she was at lunch.

"You're not going to believe this," he said.

Tiffany responded, "I have breast cancer, don't I?"

Tiffany Jones is one of a growing number of African-American women —especially young women —who are diagnosed with breast cancer every year. Breast cancer is the most common cancer among African-American women, and they are likely to develop cancer at a younger age. In fact, a new study shows that these women are 40 percent more likely to die of the disease than their white counterparts.

In Houston, a black woman is twice as likely to die from the disease, according to the research published in Cancer Epidemiology that ranked major metro areas. In Los Angeles, the risk goes up to 70 percent.

Since the 1990s, survival rates for white women have shot up, according to the findings, but have only gone up a little for black women. Why have advances in breast cancer treatment skipped black women? Doctors and researchers say that economic disparities that disproportionately affect African-Americans are to blame, as well as lack of health insurance, but genetics, culture and a history of distrust and discrimination all play a role.

The economics of illness

Jones started aggressive treatment right away, resulting in a lumpectomy, chemotherapy and radiation treatment. She is now the founder of PinkChoseMe, a foundation for women with breast cancer and survivors, and says a primary reason the women she works with don't get treatment is that they can't afford it. Jones was lucky because family and friends helped pay for her treatment, but many women are not so fortunate.

A mammogram can cost $250 to $400. A single round of chemo costs thousands. “If you work 9 to 5 without vacation and sick benefits, when are you going to go to the doctor? After work, you have to pick up your kids,” says Jones.

A survey from the American Cancer Society found that one-quarter of U.S. cancer patients put off getting a test or treatment due to cost. Director of the cancer care research program at Duke University, Dr. Amy Abernathy, did a study of 250 patients, most of whom had breast cancer. All but one had insurance, two-thirds were covered by Medicare, and nearly all had prescription drug coverage.

Still, even with insurance, their out-of-pocket expenses averaged $712 a month including medical bills, drugs and lost wages. Half skimped on food and clothes to pay for cancer medication, 43 percent borrowed money or went into debt. Over 20 percent failed to fill their prescriptions fully or took less than prescribed because of cost.

So is this largely a poverty issue? Yes — but not entirely, says Dr. Jessica Shepherd, assistant professor of OB/GYN at University of Illinois at Chicago, who is a gynecologist and women's health expert and a black woman.

According to americanprogress.org, 26.5 percent of African-American women are poor compared to 11.6 percent of white women and poverty makes it harder for to get access to good care, but that's only part of the story, says Shepherd. Breast cancer studies have been conducted mostly on caucasian women, so the research and advances favor the kinds of cancer that white women have, she says. This is in part because of a cultural mistrust of the medical community. She uses the notorious 40-year "Tuskegee Experiment," in which 399 black men with syphilis were told that they were being "treated" but were actually allowed to suffer and die from the disease so that doctors could study the effects, as an example.

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