Rates of cancer among minorities remain high White patients remain more likely to get adequate health care

September 26, 1998|By Erin Texeira | Erin Texeira,SUN STAFF

WASHINGTON -- When tens of thousands gather in Washington today for the March to Conquer Cancer, many will celebrate some hopeful news: Overall rates of new cancer cases are declining for the first time since the 1930s.

But a smaller group is highlighting a dismal footnote. Cancer rates among minorities remain high -- and in some cases are rising.

Despite research advances, treatment breakthroughs and unprecedented levels of funding, African-Americans, Latinos, Asian-Americans and American Indians get cancer and die from the disease at significantly higher rates than whites.

Explanations can be complex and controversial: Many experts cite poverty, cultural barriers and unhealthy living environments.

But, they say, the essence of the problem is simple. Minorities are less likely than whites to get adequate health care that would provide screening, early intervention and treatment for cancer.

"Last month, the announcement came that the rates are going down, but this is not equally shared by all Americans," said Lovell A. Jones, a medical professor from the University of Texas. "We have to look at the whole team as opposed to one player."

Cervical cancer rates are five times higher among Vietnamese-American women than among white women. African-American men have the highest rates of prostate cancer in the world. American Indians -- who with Native Alaskans have the highest cancer death rates of any group -- are more than twice as likely to die from lung cancer than the average American.

All Americans who live in rural areas are at higher-than-average cancer risk. Although rural communities have not been widely studied, data show that lung cancer rates exceed the national average most often in rural areas because of high tobacco use, according to the Intercultural Cancer Council, a Houston, Texas-based organization that sponsored the news conference.

Such figures underscore the fact that poor Americans -- who are disproportionately people of color -- are more likely to get and die from cancer than other groups.

Poverty has been linked with increased cigarette and alcohol use, living in unhealthy urban environments, less exercise and a less healthy diet. In addition, those with low-paying jobs are less likely to have health insurance -- or get regular check-ups.

Some 70 percent of cancer deaths could be prevented with proper screening and treatment, according to the National Cancer Institute, a division of the National Institutes of Health.

Lack of education -- more often a problem in lower-income urban areas than in more affluent suburbs -- can be life-threatening, said Judith Lightsey, a radiation oncologist with St. Agnes Hospital in Baltimore.

"We have patients [in the city] who know something is wrong -- they may feel a lump in the breast -- but they ignore it," she said. "They'll hope it goes away and they won't go into the emergency room until it has broken through the skin and is bleeding. You're not going to see that at Howard County General Hospital."

Also at issue are cultural factors, often difficult to define but dangerous to overlook, doctors say.

For example, Asian-Americans who practice Buddhism are often more likely to ignore signs of ill health for fear that they will invite bad karma by thinking about the problem, said Susan M. Shinagawa, a Japanese-American cancer patient and activist.

Many African-Americans simply don't trust doctors, pointing to cases in which blacks were subjected to inhumane medical experiments. In one of the most notorious, physicians at Tuskegee University withheld treatment from black syphilis patients from 1932 to 1972 to document the course of the disease. As a result, some victims endured years of excruciating symptoms.

Blacks are 30 percent more likely to die of cancer than whites, according to the National Cancer Institute.

Some physicians say that, exciting though recent treatment advances may be, they will do little good if they are not accessible to all. Elmer Huerta of the Washington Cancer Center said low-income patients who come for screening often learn they are ill and need further care. But many leave because they can't afford it.

Shinagawa said physicians, too, must have access to the latest research. Doctors for the 41-year-old health care worker refused to biopsy a lump in her right breast in 1991.

"They told me 'You're being paranoid,' " she said. " 'Asian women don't get cancer.' "

But current research shows that cancer rates increase among Asians when they are exposed to U.S. diet and environment.

Last year, doctors gave her two months to live. The diagnosis: breast cancer that had spread to her spine.

"My mission now is to educate people, not just in the community but also our doctors," she said yesterday. "We have a lot to learn."

Pub Date: 9/26/98

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