New breast cancer screening guide will disproportionately hurt black and Hispanic women

New breast cancer screening guide will disproportionately hurt black and Hispanic women

 

http://www.suntimes.com/news/cepeda/1899099,CST-EDT-esther23.article

November 23, 2009

BY ESTHER J. CEPEDA

The damage has been done. Hours and hours of door-to-door, woman-to-woman outreach into high risk, underinsured populations who usually wouldn't give the health of their breasts a second thought was undermined in a single moment, with a single proclamation.

Within moments of the federally funded U.S. Preventive Services Task Force's announcement last week of looser guide- lines for breast cancer screening -- no more automatic mammograms for women in their 40s, biennual rather than annual mammograms for women 50 to 74, and no more breast self-examinations -- there was outrage, confusion, disappointment.

And rightly so.

"It's difficult to even talk about the consequences of such an announcement without focusing on how absolutely wrongheaded the recommendations are and how damaging they are to the people who need them most," Dr. David A. Ansell, chief medical officer at Rush University Medical Center told me, with exasperation, last week.

As a member of the Metropolitan Chicago Breast Cancer Task Force, he was both horrified and flat-out angry as he considered the potential fallout of the confusion spurred by the news.

He wasn't alone. In fact, the push-back was so swift and intense -- interested parties ranging from the Obama administration to breast cancer survivors thought the non-binding guidance was damaging at best, borderline murderous at worst -- that the task force had to "clarify" that it did not, in fact, mean that women shouldn't examine their breasts or get mammograms in their 40s.

But it's too late.

Certain specific demographics will not be dissuaded from demanding the highest level of preventive measures during regular doctor's visits, but African-American and Hispanic women are much more likely not to have access to adequate health care, not to get regular screenings and not to get the best treatment when a screening does identify a problem. The sad bottom line is that though white women get breast cancer at higher rates, black and Hispanic women are more likely to die from the disease. How much damage these confusing headlines will do to the health of the many women who are already at high risk won't be known for years.

"Putting this out sends the wrong message," Ansell said. "It is unconscionable and a major mistake. It throws a monkey wrench into all we've been working for."

Most reasonable people agree that mammograms, like most preventive health measures, aren't always necessary or accurate. But even organizations that take their cues from health-care experts who doubt the wisdom of the current breast screening protocol, which calls for hefty testing, are reeling.

"We have had an unprecedented number of outraged people contact us in the last few days just angry and worried about what this could mean to our work," said Christina Koenig, a spokeswoman for the Breast Cancer Network of Strength. The network recently received a $50,000 first-year grant from the Metropolitan Chicago Breast Cancer Task Force to educate low-income, medically underserved women in Chicago's Hispanic communities and facilitate access to breast screening services.

"Whenever there is confusing medical news, there's always a higher chance of yet more underserved people falling through the cracks or being confused or intimidated into just not thinking about it at all," Koenig said. "But we will continue reaching into African-American, Polish and Latino communities with the message of being your own best advocate for your health."

Rarely is the medical community in complete agreement about anything, and of course the best strategy is always to take charge of your own health, but that's a message that doesn't ring loudly enough for the highest risk among us.

Regardless of how many more restatements or clarifications we hear about the best preventative measures to take against breast cancer, we may never know how many mothers, sisters and wives will be lost in this baffling skirmish.

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Rarely is the medical community in complete agreement about anything, and of course the best strategy is always to take charge of your own health, but that's a message that doesn't ring loudly enough for the highest risk among us.