 HEALTH |
The danger within: Cancer in communities of Color, Part 1
by DAMASO REYES
Special to the AmNews
Each year in New York City thousands of people die for all sorts of
reasons. Accidents, murders, old age or natural causes. What if someone
were to tell you that 500 or a thousand or several thousand lives could
be saved each year, but we simply choose not to? What would that say
about our society, about you and me? What if this were not a
hypothetical question?
In
the last year for which statistics are available, over 13,000 New
Yorkers died of cancer. More than one-third of those deaths were
smoking related, which is nearly 100% preventable. Of the others, many
of those deaths could have been prevented if only the cancer had been
detected earlier. In many cases, a few years and in some just a few
months was the difference between life, and in all too many cases,
death. Colon and cervical cancer are all highly preventable or curable
if found early, and breast and prostate cancer also have a high
long-term survival rate but only when detected early. In the year 2000,
3,433 Black citizens of New York City died from cancer, according to
the New York State Cancer Registry. The doctors and researchers tell us
that up to 3,000 of those deaths could have been prevented.
Over the
course of the next few weeks you will be reading the stories of four
New Yorkers who currently have or have had cancer. These survivors will
tell in their own words about their struggles with an enemy who resides
within all of us, using our bodies against us.
Fifty years ago, a
diagnosis of cancer was a death sentence for many people; today it is
not. But there are still far too many people within communities of
color who still believe this, and that is why so many Blacks and
Hispanics are dying while their white counterparts live. We do not get
checked, and we have less access to health care and a profound distrust
of the American medical system. And we have a fear of cancer; we
believe it is better not to know, since we will die anyway if cancer is
detected. Shattering this myth is the only thing that will save those
three thousand men and women, mothers and fathers, sisters and brothers.
The Doctor
“There
is a racial disparity that is very clear. Black men have the highest
rate of cancer, Black women have the highest death rates, poor people
in general don’t do so well when they develop cancer.”
It was a
simple, clear and profound assessment that Dr. Harold Freeman, Director
of the Ralph Lauren Center for Cancer Care and Medical Director of the
Breast Examination Center of Harlem, a community program of Memorial
Sloan-Kettering, made in an interview. A veteran of Harlem Hospital,
Freeman has worked for decades in Harlem trying to stem the rising tide
of cancer deaths within communities of color. A Lasker Award winner,
Dr. Freeman has been nationally and internationally recognized for his
work and research in cancer and why Black men and women continue to die
at higher rates than whites. A tall and lean man, Dr. Freeman gives off
more the aura of a senior manger or academic than that of a physician,
but when he speaks of the needless deaths that happen each year in our
hospitals you hear the pain in the voice of a man who has seen far too
many of those deaths personally.
“First of all you have to look at
what has gone on in America over the last one hundred years; we have
had a long history of social injustice,” Freeman said. He noted that
when the statistics were adjusted to correct for economic differences,
the differences in mortality rates between Black and whites almost, but
not quite, disappear. The fact that Blacks and Hispanics have a higher
poverty rate than white Americans is one significant reason for the
difference in survival rates but doesn’t tell the whole story,
according to the doctor. “The effect of all of this is that Black
people have fewer resources. … You can’t dismiss past social injustice
and its impact on people,” Freeman pointed out.
“Race does matter as
a determinant to people getting treatment. Even at the same economic
level, Blacks don’t get the same standard of care,” Freeman went on,
citing a study by the Institute of Medicine called “Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care.”
Clearly
there are some major issues that are beyond the control of the average
individual which contribute to the problem of cancer deaths in
communities of color. However, there is one which is in the hands of
each and every one of us: getting screened.
The Commissioner
Dr.
Thomas Frieden has that odd mix of intensity and affability that you
find in great politicians or great managers. The Commissioner of Health
and Mental Hygiene in New York City has to be both. His friendly smile
and easy demeanor belie a bubbling passion for delivering the best
health care possible to New Yorkers. Being in the same room with him
one has the sense that if someone in the room dropped to the floor of a
heart attack, Frieden wouldn’t bother to call 911; he would just roll
up his sleeves and start working right there, wherever that happened to
be. His straightforward and frank style has won him many admirers and a
few enemies, especially after he spearheaded the drive to make bars and
restaurants in New York City smoke-free.
“Smoking is far and away
the leading cause of cancer deaths,” said Frieden in a wide-ranging
interview. “If people quit smoking it would prevent 80% of cancer
deaths,” the Commissioner stated, noting that African-American smokers
are less likely to have quit than white smokers. While he repeated and
emphasized the need for individuals to take this most basic of steps to
save their own lives and the lives of those around them, he also
focused on the need for people of color to get the cancer screenings
appropriate for their age and risk factors.
If you have a history of
any type of cancer in your family, you need to be checked earlier and
more often than other people. In the case of colon cancer, this can
mean the difference between getting screened once every ten years and
once every year – that is how great the risk is. In cancers like colon
and cervical, the disease begins with polyps, or growths, which can be
either benign or the start of cancer. If these polyps are detected
early they can be tested and if found to be dangerous they can be
removed before they have an opportunity to spread. He noted the success
that the medical community has had in reducing deaths from cervical
cancer by getting women to get yearly pap smears and cervical exams.
“There
is still a stigma when it comes to cancer, and it’s important for
people to talk about it,” Frieden said when asked why people are
reluctant to get screened or tell others that they have cancer. “For
cervical and colon cancer, if you catch it early, you’re cured. If you
catch it too late there may not be a whole lot we can do,” he responded
when asked if a year or even a few months matters when it comes to
detecting cancer.
“Don’t die of embarrassment,” he said, noting he
has a history of colon cancer in his own family and as a result gets
screened more often. “You’re always better off knowing. You’ll know the
truth and the truth will set you free,” he added, noting that people
can only make a decision if they have the facts. If you don’t get
screened and have cancer, you are letting the cancer win, often when it
doesn’t have to.
The Advocate
“People are still under the
mistaken perception that cancer is always fatal,” said Ericka
Consin-Mosheshe, Executive Director of the American Cancer Society’s
Harlem branch. “If an individual feels that way, then the chances of
them going to get screened is going to be a lot slimmer,” she added. As
director of the center, her mandate is to educate the community about
cancer as well as inform them of the education, screening and support
services, often underutilized, which are available to them for free or
at low cost.
“There are a lot of people who are cancer survivors
that we may speak to on a day-to-day basis and have no clue that they
actually had cancer at some point in their lives,” Consin-Mosheshe said.
From
statistics we know that there are thousands of cancer survivors, people
for whom early detection and treatment not only prolonged their lives
but allowed them to fully recover and be cancer-free. But all too often
when the word “cancer” is mentioned in New York’s communities of color
it is with a whisper of death or prolonged illness. For many of those
people who have cancer, it is a cross they feel obligated to bear in
shame, and if they do recover they don’t want anyone to know of their
ordeal.
“People don’t want people pitying them,” Consin-Mosheshe
said, citing this as one reason so many cancer survivors are reluctant
to share their experiences. But as we will learn in the coming weeks,
more and more survivors of color are speaking up, telling their friends
and neighbors and most importantly, perhaps, their families, about what
they have been through; encouraging and inspiring them to get screened
and take their fate into their own hands. “When people survive we tell
them to tell everybody ‘I went through this and I’m a survivor and you
can be a survivor too,”’ she added.
While the history of the
American medical community’s treatment of African-Americans is dismal
(the word Tuskegee more often brings to mind those horrible experiments
rather than a great institution of higher education or a squad of
heroic fighter pilots), today in New York City there are more
opportunities and resources available to fight cancer than have every
existed, and many of them are free.
“I would say that most of
screening programs available in the community are underutilized,” said
Consin-Mosheshe. Because cancer comes from within we are all at risk.
“That’s one issue with cancer – you need to be checked before anything
feels wrong,” she added.
Years of research on the part of the
medical community have led to the simple conclusion that of the cancers
we can easily detect, including prostate, colon, breast and cervical,
most are highly if not totally curable if they are detected early, and
the only way that will happen is for each individual to be screened
according to American Cancer Society guidelines.
We live in a
society in which we have created heroes, men and women whose
contributions to the world often make our own seem small and
inconsequential. Firefighters, police officers and doctors often engage
in selfless acts of courage to save lives, but each one of us also has
the potential to be a hero to a family member, friend or total stranger
if we choose to save our own lives by getting screened for cancer. You
will hear the stories of four such heroes in the coming weeks.
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