Ongoing research highlights disparities in breast cancer
April 20th, 2015
African American women in Nebraska experience a significantly higher rate of cancer diagnoses and deaths compared to whites according to the Nebraska Cancer Registry.
In 2008, a routine mammogram for pastor and nurse Janet Goodman-Banks uncovered something suspicious. She was told she needed to see a radiologist. She did. It wasn’t long before she received the follow-up phone call.[audio:https://kvnonews.com/wp-content/uploads/2015/04/breastcancer4_17_15KVNO01.mp3]
“…And I was asked to come back for more pictures,” remembered Goodman-Banks. “Me being a nurse, I was questioning that. After going back, the radiologist came in and talked to me afterward and stated she saw something that she just didn’t like. Immediately, the tears came and she had a nurse with her who was there comforting me and told me what my options were.”
Following a second opinion and a biopsy, it was determined Goodman-Banks had not yet hit a “stage” of cancer, and only a lumpectomy would need to be performed around the tumor in her breast. She was relieved – at least until the weekend before her surgery. That’s when her nurse practitioner decided to take a second look at her chart.
“She said something told her to go back and look at my chart-even though it was prepared and she was only there to catch up on other work- something told her to go back and look at my chart. And she did,” said Goodman-Banks. “That’s when she discovered through the same pathology report that they had overlooked that the pathologist had indeed said I was a stage one.”
The new diagnosis would mean not only surgery, but now radiation therapy, commonly known as chemotherapy. She would have to meet with an oncologist, and after doing so it was ultimately determined Goodman-Bank’s condition was worse than originally diagnosed.
“She said, ‘after reviewing everything, you’re not a stage one, you’re a stage two.’ My heart just dropped. I felt a little hurt and disappointed because I’m like I’ve gone from a stage zero to a stage two within a week,” Goodman-Bank said.
Goodman-Banks’ ever-changing diagnosis may sound extreme, but as ongoing research is showing us, it isn’t all that unique – especially among African American women like herself.
Shinobu Watanabe-Galloway is an associate professor of epidemiology with the College of Public Health at the University of Nebraska Medical Center.
“Unfortunately, we heard about a few cases where treatment recommendation was incorrect and when they went to the second opinion doctor, a completely different treatment was given,” Watanabe-Gallowat said.
Over the past several years, Watanabe-Galloway and her colleagues have taken an in-depth look at the experiences of African American women who have been diagnosed with breast cancer. Their work is shining more light on something medical practitioners and researchers are becoming increasing aware of, but remains an unknown to many Nebraskans.
“In Nebraska, cancer disparities issues or any health disparities issue is kind of under the radar because we think Nebraska is not diverse enough so we don’t think of health disparities. But we have a lot of them, unfortunately,” Watanabe-Galloway said.
The disparities between white and black women with breast cancer can range from experiences involving misdiagnosis to their survival rate.
“We were not surprised but very disappointed to find out survivorship is very poor among African American women. When we look at five-year survival only close to 50 percent of African American women are still alive compared to 75 percent of Caucasian women. That information in itself is very profound, even after we took in account differences in staging,” Watanabe-Galloway said.
In a recent analysis of Nebraska’s cancer registry, her team found 7 out of 10 African American female patients resided in very low or low socioeconomic conditions. That’s compared to only 3 out of 10 for Caucasian women. Watanabe-Galloway says much of the problem boils down to socioeconomics. African American women are more likely to be without insurance to offset the high costs of cancer treatment.
“Access to care is a huge issue,” Watanabe-Galloway explained. “After the diagnosis, how long African American patients wait before they actually initiate the treatment, so it’s a time lapse between the diagnosis to the treatment. Are they going to stick with the treatment? Do they get the best treatment possible? Those things do matter.”
Watanabe-Galloway added perhaps the biggest disparity is a lack of awareness of the problem within the Black community and some medical providers, as well as the importance of regular cancer screenings.
“A lot of African American women are diagnosed at a later stage,” Watanabe-Galloway said. “Part of the reason is that the screening is not done widely among African American women. Awareness, in general, is very low in the African American community.”
It’s been almost seven years since Janet Goodman-Banks was diagnosed with stage two breast cancer. Following the news from her oncologist, she underwent six rounds of chemo. Her cancer is now in remission. A year and a half ago, she became breast cancer outreach nurse for the Malone Community Center in Lincoln, a position she says puts her face-to-face with the disparities African American women face. She says she’s quick to point women to programs like Every Woman Matters that work to subsidize health screenings in Nebraska.
“There are just so many barriers there that prevent women, especially of color, from getting or seeking the medical help or the preventive care they need concerning the cancer. (It’s my goal) to go further to find them the resources to get them a mammogram, because it saved my life,” Goodman-Banks said.
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