A new study that suggests that racial differences in biology could be a key reason black women are more likely to die of breast cancer than white women has reignited an intense debate among medical experts about the role of genetics versus factors such as poverty, diet and unequal access to quality health care.
For nearly three decades, researchers have known about the disparity in death rates, but they have been puzzled over the reasons why. In Maryland, for example, the breast cancer death rate for black women is 15 percent higher than for white women, even though African-Americans have a lower incidence of the disease. State health officials, doctors and advocacy groups have long thought a combination of factors explained the disparity and have vowed to shrink the gap through better research, aggressive treatment and outreach efforts aimed at getting black women life-saving care.
But researchers worry that a biological explanation may eclipse the real barriers black women face to getting the early preventive care that might save their lives.
Robena Pope, a breast cancer survivor from Catonsville, thinks black women, regardless of income, are reluctant to be screened for breast cancer because they think a diagnosis is a death sentence.
Years ago, the former teacher at an early child development center in Baltimore took it upon herself to educate the mothers and grandmothers of her students about breast cancer - few had ever had a mammogram. Pope invited a doctor at her primary care practice to come to the school to offer education sessions on breast cancer with the women. The effort is now an annual outreach event.
"Even women who had insurance, they didn't want a mammogram," she said. "They just didn't want to know."
The newest national study on the problem examined some 20,000 adults with various cancers and found that blacks were more likely than whites to die of three gender-related cancers - ovarian, prostate and breast. The disparity persisted, even when patients received the same treatment and when researchers adjusted for factors such as age, income and the severity of the illness.
The risk of dying for blacks was 41 percent higher than whites for breast cancer before menopause, and 49 percent higher for post-menopausal breast cancer, according to the paper, published this month in the Journal of the National Cancer Institute.
