Friday, March 1, 2024

SEEN UP NORTH: Racial divide in US breast cancer care


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Fact or fiction?

When many women from Barbados, Jamaica, St Lucia or any of their Caribbean neighbours, land at New York’s JFK Airport, they head to public City hospitals, such as Bellevue or Kings County Medical Centre.

Why? To receive treatment for breast cancer.

“It’s a fact. They come with their mammograms in order to get high quality care for breast cancer,” said Dr Kathie-Ann Joseph, director of breast services at New York City’s Health and Hospitals Corporation South Manhattan Network. “As a City hospital we can’t turn them away.”

And that’s true despite the fact that the visitors may not be American citizens, aren’t green card holders or may even be classified an undocumented immigrant. They are simply seeking the best quality treatment for a disease that takes the lives of tens of thousands of black women across the United States every year.

“We have to provide care to the women regardless of their immigration status or ability to pay,” explained Dr Joseph, an associate professor of surgery at New York University’s Langone Medical Centre in Manhattan. “We must treat them in the same manner and with the same efficiency as any other patient who turns to us.”

Actually, the surgeon wasn’t sending a message to Caribbean women about ways to beat the medical system. Far from it. Instead, she was outlining to a largely Barbadian female audience the inequities in breast cancer services in the United States and why so many black women die every year from the disease. The Bajans were at the Kingsbrook Jewish Medical Centre in Brooklyn a week ago for an annual cancer symposium organised by the Barbados Cancer Association USA (BACA), Inc., the Caribbean American Medical & Scientific Association (CAMSA), Inc. and the Barbados Nurses Association of America.

Joseph’s words of wisdom were straightforward enough: Although black women in the United States are less likely than white women to get breast cancer, they have a higher death rate.

“That’s a fact,” said Joseph. “There is a racial divide in breast cancer care in the United States.” It emerged in the 1960s and hasn’t disappeared since.

How come? “There is a systemic barrier that is preventing black women from getting the care they need to treat the disease,” said the surgeon specialist, a Jamaican.

Dr O’Neall E. Parris, a Barbadian pediatrician who is BACA’s chairman agreed.

“It is well documented that minority (black) women in the United States have fewer choices than the majority (white) female population when it comes to breast cancer and access to care in the US,” said Parris.

“Where you live, your socio-economic status, health insurance and so on affect your access to quality care. If you live in an area with limited resources you can end up seeking care at a facility where the clinicians don’t have the breadth of experience or access to resources of their colleagues at much larger institutions.”

What the audience heard underscored the problem black women in the United States face:

 Blacks with breast cancer are 40 per cent more likely to die from the disease than their white counterparts,” Dr Harold P. Freeman, a past president of the American Cancer Society, wrote recently.

 Young black women tend to develop a particularly aggressive form of the disease.

 The United States Centres for Disease Control insists females of colour experience significant delays in diagnosis and treatment.

 The disease tends to appear in black women at a younger age and in more advanced forms than in whites.

“The major issue for black women is access to care,” said Parris, who was quick to point out that early diagnosis and the provision of top quality care at institution which treat cancer patients in large numbers were vital to the chances of survival. “The delay in services can be a serious problem.”

That’s why many Caribbean women head to New York for care.

The idea for the annual symposium was first proposed in the 1990s by George Griffith, at the time Barbados’ consul general in the city. 

Dr Debra Brathwaite, a Barbadian physician and rehabilitation specialist at Kingsbrook Medical Centre was a keen organiser of the symposium. She died last December from the disease and BACA has renamed the symposium in her honour. Brathwaite’s daughter, Sharifa, and her sister, Gail Brathwaite, a top banking executive in Connecticut, spoke at the event.


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