Connections: A Racial Divide

A significant racial gap in breast-cancer mortality rates

    A story in The New York Times on March 3 brought into more vivid focus all the news these days about the Affordable Care Act. At least for me, it reverberated more strongly than all the statistics about those who remain uninsured.

    Tara Parker-Pope, in a “Well” column, reported on a significant racial gap in breast-cancer mortality rates that has been revealed by the compilation and analysis of deaths caused by the disease in 41 American cities from 1990 through 2009. The data showed that, beginning in 1990, the risk of mortality for white women fell dramatically in many of these cities — as might have been expected given the advances in treatment since then — but that the number of deaths dropped very little among black women.

    Disparaging the notion that the gap might be the result of genetics, the article was unequivocal about the reasons for this grim disparity: Black women were more likely to die of breast cancer, it said, because of “lower-quality screening, less access to treatment, and lower-quality treatment.” On average, Ms. Parker-Pope reported, 40 percent more blacks than whites were likely to die of the disease in the years studied.

    Boston, Chicago, and Dallas were among those cities with the largest disparities. So was Los Angeles, where about 70 percent more black women than white women died of the disease during the research period. Isn’t that a shocking figure?

    New York City, I was somehow pleased to learn, had a comparatively small racial gap. This, apparently, has been attributed to the city’s public-hospital system as well as readily available public transportation (eye-opening, I thought, as we don’t usually think of subway and bus service as a health advantage).

    Steve Whitman, director of the Sinai Urban Health Institute, one of two agencies that conducted the research, called the results “startling and very dismal because there is hardly any health measure in the United States that hasn’t improved in the last 20 years.”  

    Dr. Whitman called the disparity “systemic racism.”

    We should not be surprised. “The system is arranged in such a way that it’s allowing white women access to the important gains we’ve made since 1990 in terms of breast health, and black women have not been able to gain access to these advances,” he said.

    The study has hardly set off media shockwaves. The Times ran the story on an inside page, on a Monday.

    I am one of myriad women who have had a malignancy removed from a breast surgically, but I was among those fortunate enough to have had a kind of cancer (ductal in situ) that is non-invasive and highly treatable. Unlike the women cited in the column in The Times, I also was lucky because I am white and had a primary-care physician at the time who was one of New York City’s finest.    It can often be hard for many of us in the Caucasian majority to grasp the concept of  white privilege, but I think anyone who reads these numbers will get it.