Cancer deaths still follow racial lines

When Ulysses B. Hammond was diagnosed with prostate cancer, his first thought was that he could wait to deal with it. After all, the doctor said it would spread slowly.

That reaction is typical for men - especially African American men like Hammond - and it plays a role in explaining why they have the highest cancer death rate in Connecticut and in the nation.

"It's not deemed very macho to actually admit or discuss physical frailties," said Hammond, chairman of the board at Lawrence & Memorial Hospital in New London.

The death rate for African-American men and women nationally - 207.7 per 100,000 people - is more than 20 percent higher than the rate for whites, according to 2009 data, the most recent available from the National Cancer Institute. Connecticut's rate is 179.3 for blacks and 167.8 for whites.

The numbers for African-American men alone are even more striking. Nationally, their death rate is 274.7, compared to 209.8 for white men. In Connecticut, the rate is 230.9 for blacks and 204.3 for whites.

Narrowing gaps like this is a top priority for health policymakers here and nationally. Early efforts have seen some progress; death rates for many cancers are down.

"But we're still seeing a wide range of disparities in almost every area," said Elizabeth Krause of the Connecticut Health Foundation, which has invested almost $15 million in health equity since 1999. "We've really got to focus our efforts on advancing solutions."

The motivation is more than altruistic. It's financial.

When cancer patients don't have health coverage, don't trust physicians or won't confront their own vulnerability, their diagnosis is late and treatment is expensive. Those delays added $230 billion to U.S. medical costs between 2003 and 2006, according to the Joint Center for Political and Economic Studies. So the payoff for improving care - starting with prevention - could be enormous.

Policymakers, researchers and practitioners are only beginning to understand the complex role race, culture, education, income level and even biology play in determining whether a person gets cancer, how soon it's detected and whether it will be fatal.

The focus now is on strengthening public health and prevention. Practitioners are looking for innovative ways to reach out to underserved people - whether African-American men who won't talk about cancer, or transgender women who don't get screenings because they feel disrespected by their doctors.

"We are finally getting our act together and beginning to understand that we just can't do things in the absence of bringing the community together at the same table. We need them. They are experts," said Marie Spivey, vice president for health equity at the Connecticut Hospital Association and chair of the Connecticut Commission on Health Equity.

Disparities are complex. Some follow income lines that drive lifestyle choices, education and access to health care. Others are cultural. People speak different languages, have different attitudes toward health and wellness, and interact with health providers in different ways. And others are biological.

Why, for example, do African-American women have a lower incidence of breast cancer than white women, but a higher death rate? The most recent Connecticut data show that the incidence is 118.9 per 100,000 for African-American women and 139.7 for whites. The death rate, though, is 25.9 for African Americans and 21.4 for whites.

One thing is obvious, said Anees Chagpar, director of the Breast Center at Smilow Cancer Hospital at Yale-New Haven Hospital: Insurance is a main driver of disparity. "At the most basic level, if we can provide health care evenly across the board, we have done a great service."

Health officials say the Affordable Care Act will help by expanding coverage to more people, focusing greater attention on preventive health, and centering care on individual needs.

The William W. Backus Hospital in Norwich, for example, is matching low income patients with primary care physicians for follow-up after they visit the Emergency Department or the hospital's mobile care van. Another program with the NAACP takes breast cancer screenings to churches, temples, salons and senior centers.

"These kinds of collaborations and partnerships - getting people connected - those things really make a difference," said James O'Dea, a vice president at Backus and administrator of the hospital's cancer services program. "For the first time in my 25 years in health care, we are genuinely talking about a health care system, instead of a sick care system."

Baker Salisbury, chairman of the Health Equity Committee of the Connecticut Association of Directors of Health, said equity efforts must compete with discouraging socioeconomic trends. "The growing inequality of our society is hugely evident in Connecticut," he said.

Hammond has seen the disparity issue both as a patient and as a health care leader. At L&M, he helped break ground in June for a $35 million cancer center in partnership with Boston's Dana-Farber Institute. And as a cancer survivor, he's talking openly about his experience. A vice president at Connecticut College, he opted for surgery after his initial hesitation and is doing well today.

He tries to reach out especially to African Americans and Latinos because of the cultural challenges they share.

"They know that I get it," he said. "We can communicate."

This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).

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