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The danger within: Cancer in communities of Color, Part 1
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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