Four women — three black, one Hispanic — sat slumped in their powder blue gowns in Mount Sinai Hospital's mammography center recently. Each woman hugged herself with both arms, cradling her breasts in between. They sat low and in a row.
In Chicago, nearly 80 African-American women die of breast cancer every year because of racial differences in access to healthcare, a new study suggests, the worst number of any city in the study.
Overall, Chicago had the fifth highest gap between breast cancer deaths among black women and white women, the study found. The study, lead by the Sinai Urban Health Institute's director Steven Whitman, used death certificates to calculate the cancer mortality rates of the 24 largest cities in the United States and found that black women were more likely to die of breast cancer than white women in almost all of them.
Residential segregation and median household income were the only two risk factors to significantly influence racial disparity in breast cancer mortality because they affect access to care.
"Black people tend to be segregated into these isolated enclaves and they're far away from facilities that can serve them well and help improve their health," Whitman said. "Segregation in general has been found to impact many areas of health, and one of them we've just discovered is breast cancer."
Chicago is the most segregated of the 10 largest U.S. cities, according to a January report by the Manhattan Institute for Policy Research based on census data.
Centralized system part of the problem
The distance from facilities can deter regular screening, which in turn means breast cancer is often diagnosed when it has reached a late stage, according to Jennifer Orsi, a co-author on Whitman's study and senior data coordinator at the Metropolitan Chicago Breast Cancer Task Force, a nonprofit organization dedicated to fighting health inequalities.
Cities with higher mortality rates were also cities that had centralized public health systems, as in Chicago and Los Angeles, said Richard Warnecke, professor emeritus of epidemiology, public administration and sociology at the University of Illinois at Chicago. In contrast, New York City's health system is decentralized with public hospitals dispersed throughout its boroughs.
"Here we have Provident and Cook County [hospitals], and that's for the whole county," Orsi said. "New York City's public health system is funded at a much higher rate, as is their Medicaid rate. When you factor all of those, they can all play a role in addition to segregation."
Warnecke, who was not involved in the study but has researched economic, racial and ethnic disparities in breast cancer as well, places less emphasis on the role of Chicago's racial divisions, however.
"I don't disagree with the findings, but segregation itself probably isn't a direct effect on health as much as the de facto issue of what's available in these neighborhoods that are predominantly poor," he said.
Seeking a healthier Chicago
The problem is not that black women are dying from breast cancer more than they were in the past, but that white women are dying less, according to a 2008 paper published in the journal "Cancer Causes & Control." The mortality rate for black women has remained the same in the past 20 years; however, the rate for white women decreased in the 1990s due to advances in diagnosis and treatment.
"Breast cancer has been very successfully treated in large measure because it has been found with new techniques," Warnecke said. "If [black women] aren't getting those techniques and they're not screening, then they're not going to benefit from them. It's the access to care and the way in which resources are distributed."
The Chicago City Council last week took action to improve the distribution of resources. It passed an ordinance opening the way to contract with five area hospitals to provide both screenings and follow-up care, as a part of Healthy Chicago.
"We're making changes to our system to increase access to care," Dr. Bechara Chouchai, commissioner for the Chicago Department of Public Health, said in a press release. "This ordinance allows us to link patients with abnormal mammogram results to follow up services more effectively."
Warnecke added that "[Healthy Chicago] is a very good program because they're addressing these issues. They run their own clinics."
Currently, breast cancer patients may have to go to one clinic for their mammograms and then another clinic to have them read. The city aims to increase efficiency by having the same provider conduct the follow-up, which it said could help some patients save time traveling.
State cutting screening funds
In the meantime, the state government proposes to cut $3.3 million from the Illinois Breast and Cervical Cancer Screening Program, which provides mammograms to low-income or uninsured women throughout the state.
As of April 10, 19 out of 36 designated providersno longer had enough money to continue screening mammograms. In Chicago, all but one, the Erie Family Health Center, are in this situation. Their waiting lists total more than 3,000 women, according to the Illinois Department of Public Health.
"The problem with that is that in fiscal year 2012, facilities providing that program already started running out of money in January, in just over six months," Orsi said.
The Metropolitan Chicago Breast Cancer Task Force and state chapter of the Susan G. Komen for the Cure will meet with Gov. Pat Quinn Wednesday to discuss the cuts and ask for $25 million in state and federal funds.
The Illinois Humanities Council will hold a screening of Pink Ribbons, Inc, along with a post-show panel including Dr. Whitman, in Chicago on Thursday, August 2nd. See here for more details.