12 Scientific American, May 2019FORUM
COMMENTARY ON SCIENCE IN
THE NEWS FROM THE EXPERTSIllustration by Benjamin CurrieJanice Phillips is an associate professor at Rush University
College of Nursing, director of nursing research and health equity
at Rush University Medical Center, and a Public Voices Fellow
with The OpEd Project.If You’re Poor,
Don’t Get Cancer
People without resources
have higher death rates
By Janice PhillipsAlthough the U.S. has experienced a 27 percent de cline in can-
cer death rates during the past 25 years, the drop has not bene-
fited everyone equally: poor in dividuals and people of color
have significantly higher mortality than this average.
One reason for the disparity is that people living in poverty
have lower rates of routine screening, as well as a lower likeli-
hood of getting the best possible treatment, and African-Amer-
ican, Native American and Hispanic people are more likely to be
living in poverty than are whites and Asians. A recent study in
the journal Cancer Epidemiology, Bio markers & Prevention, for
example, shows that black and Hispanic women in Chicago wereless likely to be diagnosed at top-tier centers as compared with
their white counterparts.
When I worked as a nurse clinician in an underserved com-
munity on Chicago’s South Side, an area known for high breast
cancer mortality rates, I saw how hard it was to refer women with
symptoms of breast problems to our leading academic medical
centers for care. Uninsured women, in particular, were more
often than not referred to our county hospital, which had fewer
resources and reduced state-of-the-art diagnostic capability. Even
today zip code and insurance status can influence whether or not
women receive breast cancer care at centers of excellence.
And although breast cancer survival overall has improved
over time, the American Cancer Society affirms that disparities
remain: the five-year survival rate is 92 percent for white wom-
en but 83 percent for black women; the latter group is more like-
ly to have more aggressive tumor types and to be diagnosed at a
later stage of the illness, both of which are contributing factors
to cancer outcomes. In 2015 black women were 39 percent more
likely to die from breast cancer as compared with white women.
I have identified additional treatment barriers affecting
women as young as 20 in my own studies with African-Ameri-
cans. African-American women younger than 40 have shared
with me that providers do not take them seriously when they
present with breast concerns, claiming that they are too young
to have breast cancer. I know from firsthand experience that
young African-American women and their families are frustrat-
ed with the health care delivery system, especially if they are
uninsured or underinsured.
Cancer advocates have sounded the alarm about these dis-
parities for years. In 2007, for example, the Metropolitan Chica-
go Breast Cancer Task Force found a 68 percent higher death
rate for black women as compared with white women. These
findings helped to shape public policy and inform citywide and
statewide initiatives aimed at addressing system is -
sues such as access to high-quality mammography
screening. I was thrilled to see these attempts to lower
barriers in the health care system itself, rather than
the traditional focus on changing behavior in patients,
who should not be blamed when hospitals, doctors and
insurance companies fail to provide them with good
care. Because of the tremendous efforts of the task
force and other partners, Chicago is leading the nation
in reducing the racial gap in breast cancer mortality
when compared with the other nine U.S. cities with the
largest African-American population in a 2017 study.
(The reduction in breast cancer mortality in the city
may be attributed, in part, to the task force’s compre-
hensive work.)
Even though the impact is greatest for women of
color, it extends to uninsured adults of every ethnic
background. For example, people without insurance
are more likely to postpone or forgo health care alto-
gether—and a recent Gallup poll noted that three in 10
Americans do not seek medical care or defer treatment
because of cost. And this problem is getting worse: a study by
the Kaiser Family Foundation showed an in crease in the num-
ber of uninsured from 2016 to 2017 of nearly 700,000—primar-
ily in states without Medicaid expansion. Eleven percent of
blacks and 19 percent of Hispanics are uninsured as compared
with 7 percent of whites.
Surviving cancer should not be determined by your ethnici-
ty or your income level. But until the gap in access to affordable
good care is eliminated, that will be the prognosis.JOIN THE CONVERSATION ONLINE
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