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Breast Cancer Strikes Poor the Hardest

Nine-year survey shows low-income women have more advanced cases

FRIDAY, Jan. 11, 2002 (HealthDayNews) -- Illness strikes both rich and poor, but a new study confirms the wealthy may be better equipped to act before it's too late.

Researchers found that upper class New York City women were more likely than their poorer and less-educated peers to get breast cancer diagnoses before the disease had progressed to an advanced stage.

The consequences of such differences are "ultimately fatal," says study co-author Sharon Stein Merkin, a graduate student at the Johns Hopkins Bloomberg School of Public Health.

"If cancer is missed and women are diagnosed with advanced forms, their chances of survival are simply lower," she says. "Considering that we have effective screening measures, it's important to help everyone get access to them."

While at the New York City Department of Public Health in 1999, Merkin and a colleague examined breast-cancer statistics for the years 1986-1995. A total of 37,921 cases were analyzed.

Breast cancer is the second-leading cause of cancer death among women, trailing only lung cancer, and the American Cancer Society (ACS) estimates it will kill nearly 40,000 women this year.

The researchers determined the approximate education and income levels for the women based on the zip codes in which they lived. They then looked for mathematical patterns.

The study showed that lower levels of education and income increased a black woman's odds of being diagnosed with advanced breast cancer by 50 percent. A white woman's odds grew even more, by 75 percent, with more poverty and less education. The numbers are based on 2,436 black women and 2,624 white women at lower education levels.

The findings appear in the January issue of the American Journal of Public Health.

Experts already know white women are more likely to get breast cancer than black women after age 40, but survival rates among black women are a bit lower, apparently because they show up at doctor's offices with more serious cases, according to the National Cancer Institute and the ACS.

Women with advanced breast cancer are at much higher risk of dying than women with milder cases. From 1989-1996, the five-year survival rate for women with localized breast cancer was 96 percent, while it dropped to 21 percent for those whose cancer had spread to distant parts of their bodies.

It's not clear why the gap exists. Poor women may delay treatment when they feel ill or decline to get routine mammograms, Merkin says. The stress of being poor could also be a factor.

While there is continuing debate over the value of mammograms, a Swedish study released last fall suggested that regular use of the procedures could reduce deaths from breast cancer by 63 percent.

The ACS has had some success with programs that teach volunteers to spread the word to friends and relatives about the value of mammograms, says Eve Nagler, director of programs for special populations.

Many poor women don't understand the value of mammograms or don't think they need them, Nagler says. The volunteers work to educate them about why they need to be examined.

Women with low literacy skills who may not have read about mammograms "can understand the message because they can feel the passion and compassion of their friend saying, 'I really care about you. You need to do this in order to save your life.'"

What to Do: For an overview of breast cancer, including genetic issues, go to the National Cancer Institute or the American Cancer Society.

SOURCES: Interviews with Sharon Stein Merkin, graduate student, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore; Eve Nagler, MPH, director, special populations programs, American Cancer Society, Atlanta; January 2002 American Journal of Public Health
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