Closing the Gaps on Breast Cancer Mortality Rates Researchers for the Susan G. Komen foundation find reasons for high numbers of breast cancer-related deaths in eight U.S. communities.
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Closing the Gaps on Breast Cancer Mortality Rates

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Closing the Gaps on Breast Cancer Mortality Rates

Closing the Gaps on Breast Cancer Mortality Rates

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This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.


And I'm Melissa Block.

What accounts for high breast cancer mortality rates in certain communities? What disparities in screening and treatment help determine who survives breast cancer, and who doesn't? Those are two of the questions taken on in a new breast cancer study. Researchers looked at eight locations in the U.S. with high death rates from breast cancer, among them urban centers like Harlem, New York and rural areas like Madison County, Mississippi.

Dr. Harold Freeman was principal adviser for the study. He's a cancer surgeon and senior adviser to the director of the National Cancer Institute. Thanks for coming in.

Dr. HAROLD FREEMAN (Principal Adviser, "Susan G. Komen for the Cure of Breast Cancer Mortality Report"; Cancer Surgeon and Senior Adviser, National Cancer Institute): It's good to be with you.

BLOCK: Dr. Freeman, I wonder if you could give us a sense of the most striking discrepancies here, the breast cancer mortality rates that you saw in these communities compared with the U.S. overall?

Dr. FREEMAN: Well, first of all, the United States rate is 26 deaths per a hundred thousand. One of these counties of the eight is the Madison County in Mississippi where there's 53 deaths per hundred thousand - double the national average. And in between there are other rates of death.

So what we attempted to do here was to find communities in America where the death rate was higher than the national average and to focus on eight of these communities, to drill down to see what was happening in these communities, the cause of these results, which are unacceptable.

BLOCK: And what common trends, demographically, did you find among these eight communities?

Dr. FREEMAN: Demographically, the trend that connected all eight communities is poverty and lack of education. Also, a lack of infrastructure in these communities where people don't have access to hospitals and to screening, sometimes, in a few of these communities, transportation and distance becomes an issue. But the overwhelming problem is poverty and lack of health-care coverage.

BLOCK: And in some cases, it seems lack of awareness about treatments that may be available that people don't know about it.

Dr. FREEMAN: Yes. In fact, what I would say is that when people are poor in general, they have less knowledge and less education. And that's when I saw the issue of poverty is much broader than its medical implications. Poor people will have poor housing conditions, less social support. Often, poor people have a risk-promoting lifestyle like the wrong diet, heavy smoking. And in addition, poor people have low access to preventive and early health care.

Surely, all people who have cancer ultimately will get into the hospital. But people who get into the hospital for treatment too late, they will die. And so poverty is a driving issue. But also associated with this there are people who have no health insurance, who are not poor, but the problem of not having access because they just can't get into the health-care system because they have no insurance is also a devastating issue.

BLOCK: It seems to me that a lot of the things that this study talks about -lack of access to health care, paucity of mammogram machines, not enough people to read mammograms when they happened, lack of transportation - these are things that we've known about for years. We shouldn't be surprised to read what's in this report it seems to me.

Dr. FREEMAN: You know, we really shouldn't be surprised, I agree with that. The point is that this is actually happening to real people. When you put real faces on the problem, if the problem that comes up - a little more distinctly, and if you go to communities where you can show that there are real problems that are fixable, where you can correct the situation.

A very good example is in Harlem. We increased the five-year survival from breast cancer from 39 percent to 70 percent by some very simple things that we did - provided screening for breast cancer beginning in 1979 for all women, irrespective of their ability to pay, and in 1990, adding patient navigation so that screened women had a way of getting rapidly through the health-care system through resolution.

BLOCK: When you say patient navigation, what do you mean?

Dr. FREEMAN: We bring principally, community people into the health-care system and make them patient navigators. The people that we choose to do this are from their own communities. They speak the same language and we trained them, teach them methods to get people through the system, including ways to get people onto health-care programs, including getting people through the system because of its complexity, and sometimes, it's talking to people to give them the confidence and beliefs that they can get in the system and get through the system.

So the navigator concept seems to work. It's also cost-effective. People who have cancer in America will be treated at some point in the state of their disease. The moral question and ethical question is: Will we treat them early enough to save their lives or will we treat them later at a higher cost and with loss of life? I don't think we save money by not treating people with breast cancer.

BLOCK: Dr. Freeman, thanks very much.

Dr. FREEMAN: Thank you.

BLOCK: That's Dr. Harold Freeman. He's the principal adviser for the "Susan G. Komen for the Cure of Breast Cancer Mortality Report." You can read a summary of the study's findings at

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