Breast cancer report shows minorities face disparities

March 05--A new report on breast cancer patients treated in Lucas County shows disparities remain for minority patients and those with Medicaid or no insurance when it comes to diagnosing cancer in early stages.

The 2017 Breast Cancer Report to the Community, created by the Lucas County Breast Health Coalition, compiles for the first time patient demographic data from the county's four health systems' cancer centers -- Mercy Health, ProMedica, St. Luke's Hospital, and the University of Toledo Medical Center, the former Medical College of Ohio. The report uses patient demographic and cancer-stage data from 2010-2014.

White patients were diagnosed in the early stages 86 percent of the time, compared with 78 percent of black patients. Patients with private insurance or Medicare fared better in early diagnosis than those with Medicaid or no insurance.

Of the slightly more than 4,000 patients studied, the youngest to be diagnosed was 22 years old; the oldest 101. Median age at diagnosis for all stages was 61.

Overall, 86 percent of breast cancer patients during this time period were diagnosed in early stages 0-2, according to the report -- including 43 percent in Stage 1 and 26 percent in Stage 2. Lucas County's figures mirror national statistics, said Andrew Mariani, spokesman for the breast health coalition and author of the report.

VIDEO: Blade Briefing -- Lauren Lindstrom on Breast Cancer Report to the Community

Early detection and treatment is crucial for better survival rates, said Mr. Mariani, also the health system and hospital manager for the American Cancer Society's East Central Division.

"[Breast cancer in the] localized stages 0, 1, and some stage 2 have an over 90 percent five-year survival rate," he said. The five-year survival rate for stage 3 breast cancer is about 72 percent, according to data from the American Cancer Society; the five-year survival rate for stage 4 breast cancer is about 22 percent.

"We have a huge number of women surviving it, which is what we want," Mr. Mariani said of the local figures. "It makes us feel good about previous messaging campaigns about early detection, getting mammograms, and that our local cancer centers' outreach is making an impact."

Some cancers diagnosed in later stages are curable, Mr. Mariani said, but the treatments are harsher and costlier. Patients might have to miss more work, incur more medical bills, and suffer more severe side effects.

Screenings urged

Delphine Fuller-Brown, 64, was diagnosed with stage 2 breast cancer in August after a mammogram flagged potential abnormalities. After she had two benign tumors removed in her late teens and 20s, she's been screened every year. Still, she had a hard time coming to terms with her diagnosis.

"Who would have ever thought I would end up with the word cancer," she said. "Until it happens to you, you don't believe it."

Ms. Fuller-Brown encourages the women in her family and her friends to get mammograms and screenings.

"Don't say it won't happen to you, don't be foolish," she said. "Please get that mammogram so you can have a little peace. And if it's not [the result] you want, you know what you've got to do."

Mrs. Fuller-Brown has three chemotherapy treatments behind her, with three to go. She will undergo radiation after chemo, and her doctors tell her that her prognosis is good. In addition to screenings and proactive measures, she said she'd like to see more done to support cancer patients after diagnosis.

'Message of hope'

Dr. Iman Mohamed, medical director of the Comprehensive Breast Center at the UTMC Cancer Institute and chief of Hematology/Oncology division, said she wasn't surprised by the findings in the new report. She said she was encouraged to read only 4 percent of breast cancer is diagnosed in stage 4, slightly lower than national statistics.

"Can we do better? Yes, but we're OK," she said. "It's a testament to the promotion of screenings. You cannot diagnosis early cancer without screenings."

Some aggressive cancers only present themselves in later stages, she said, which will always be a challenge for treatment. But Dr. Mohamed also has studied why some women delay seeking medical treatment after finding a lump during a self-exam. She found that fear paralyzes some women and keeps them from taking action.

"It's the 'I'm scared, I'm stuck,' " she said, adding that this is a place where health-care providers can better communicate with patients and the broader community.

"The message needs to be a message of hope," she said, adding, it's also important to find the right messenger.

"You have to have the right people approach the right community when reaching out to minority populations," she said. "It really doesn't help someone who looks like me, or someone who is blond, to go to a black church."

Geographical disparity

In all, patients from 170 ZIP codes received care at a Lucas County cancer center, coming from cities outside the county such as Defiance and Port Clinton, Mr. Mariani said. Geographic distribution shows differences in stage at diagnosis.

Patients living in 43615 -- which runs through parts of West and South Toledo and parts of Ottawa Hills -- were diagnosed in stages 0-2 86 percent of the time and stages 3-4 14 percent. That split also reflects the area's average distribution.

But 33 percent of patients living in North Toledo's 43608 were diagnosed in stages 3-4, the highest percentage of later stage diagnoses of the 30 top ZIP codes by number of patients. It was also higher in downtown's 43604, where 24 percent of patients were diagnosed in stages 3-4, and in 43607 in South Toledo and the central city, where 20 percent were diagnosed in later stages.

Faring better were patients from 43616 covering Oregon and Harbor View, 8 percent were diagnosed in stages 3-4, and Sylvania's 43560, where 9 percent were.

ZIP code data can be used to better target neighborhoods for outreach, said Deb Ross, Mercy Health oncology education coordinator.

"It gives us some areas where we can focus our interventions," she said of the report. "That shows us where we can go out there, provide education, and make better connections." She said nontraditional locations for disseminating health information, such as a beauty shop or grocery store, could help reach women who don't seek medical care often.

The Mercy Health mammography assistance program offers breast-health education and mammograms to uninsured and underinsured women, and last year performed 184 mammograms and ultrasounds through grant funding, Ms. Ross said. Information from the report can help tailor their efforts.

"That's the message for our health system, you've been given this gift, you have the data, what are you going to do about it?" she said. "I think we have a lot of work to do to make sure our community stays healthy and we're taking care of people, especially where we see it's needed the most."

Robin Sulier-Charney, oncology outreach coordinator for ProMedica Cancer Institute, said the breast-cancer report mirrors other health challenges in the same areas and demographics. Many of the ZIP codes that have higher instances of later-stage breast cancer diagnoses overlap with areas that have higher instances of prostate cancer, chronic disease, or barriers to health-care access.

She said ProMedica uses data like this new report, and the county's health improvement plans to determine "what we need to do, where we need to do it, where those gaps are," she said. "We're trying to move the needle in those ZIP codes."

Contact Lauren Lindstrom at [email protected], 419-724-6154, or on Twitter @lelindstrom.

Related Items

Lauren Lindstrom, breast cancer, Breast Cancer Report to the Community, Lucas County Breast Health Coalition, mercy health, Promedica, St. Luke's Hospital, university of toledo medical center, Delphine Fuller-Brown, Dr. Iman Mohamed, ProMedica Cancer Institute

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