Undetected Breast Cancer in Black Women

335 Brief communication UNDETECTED BREAST CANCER IN BLACK WOMEN TOTHEeditor: Whileearlydetectionprogramssuccessfullyreducemortality from breast cancer, I found in a recent examination of breast cancer programs in Illinois that many women do not have adequate access to such services. I urge health planners throughout the nation to examine access to breast cancer programs in their states. In the United States, breast cancer leads all other cancers in incidence (28 percent of all cancers in women) and is the second leading cause of cancer death.1 Each year in Illinois, there are an estimated 6,700 new cases of breast cancer, and 2,100 deaths due to breast cancer.2 For black women, breast cancer leads all other causes of cancer mortality .2,5 The survival rates for breast cancer in black women of all ages are approximately 12 percent lower than in white women3, although the incidence of breast cancer is lower among black women in the over-40 age group.3-4 The lower survival rate has been attributed to delays in treatment6, socioeconomic disparity between blacks and whites7, inadequate access by black women to screening5, and different characteristics of tumors.9 Screening and early detection have successfully reduced mortality.10"12 In Illinois as elsewhere, it is likely that early detection programs that stress the importance of breast self-examination (BSE), clinical breast examination, and mammography could reduce deaths due to breast cancer. In addition, programs targeted specifically for black women could narrow the difference in mortality rates between white and black women. Breast cancer detection services are available to many Illinois women. As of January 1,1991, Medicaid in Illinois will pay for a baseline mammogram for women age 35 to 39, screening mammography every one or two years for women age 40 to 49, and yearly screening mammography for women over 50 (Illinois Dept. of Public Aid, personal communication). Medicare will pay for a mammogram only if there is evidence of disease (Health Care Financing Administration, personal communication). Illinois Public Act 86-0899, enacted January 1,1990, requires every provider of group or individual health insurance, including health maintenance organizations, to provide coverage for Journal of Health Care for the Poor and Underserved, Vol. 2, No. 3, Winter 1991 336__________________________________________________________ mammography, using the same guidelines as Medicaid for frequency of mammogram with age (Illinois Dept. of Insurance, personal communication). But women who are neither insured nor eligible for Medicaid must pay at least $50 out-of-pocket for a mammogram. These women often rely on public health departments for assistance. A telephone survey of 18 county and local health departments in Illinois revealed that mammography is available to health department patients in only one area of Illinois—the Englewood neighborhood of Chicago. When asked, all of the departments surveyed cited lack of funding as the major barrier to providing services. Local health departments receive an average of 10 requests for mammography screening each year and usually refer patients to hospitals, local clinics, and private providers who accept Medicaid. When local health departments were asked if they would like to receive more information on funding for mammography, every department responded affirmatively. The Centers for Disease Control (CDC) will grant $13.5 million in 1991 to five state health departments for breast cancer screening of low-income women (Centers for Disease Control, personal communication). Dr. Robert Smith of CDC has stated that funding is "expected to ultimately be given to all 50 states." The Illinois Department of Public Health (IDPH) is applying for one of these contracts. IDPH plans to add mammography to its computerized follow-up system in Chicago and to administer the remaining funds through the Division of Family Health within the Office of Health Services. In turn, the Division of Family Health will request proposals from local health departments for consideration for funding (M. Mattuck, personal communication). In order to significantly improve women's health, public health leaders must examine the need for early detection and treatment of breast cancer. Programs should focus on providing mammography for the women who fall through the cracks of the present system—those who lack health insurance and who are not eligible for Medicaid. In addition, educational programs stressing the importance...