The Deadly Difference

Black women in Chicago are far likelier to die of breast cancer than white women, resulting in a disparity that's nearly double what it is nationally. This pattern of racial inequality shows up locally with other diseases—evidence that Chicago is failing at narrowing its racial divide in health. Why? And what must be done?

(page 6 of 7)

For Rush University Medical Center's David Ansell—who helped set up Chicago's first breast and cervical cancer screening program at Cook County Hospital in 1984—the relentless pace of breast cancer mortality among black women in Chicago came to feel deeply personal. Ansell had dedicated his career to fighting the disease, to saving lives. Yet the undiminished death rate among African American women afflicted with the disease whispered to him of failure.  "I looked at 20 years of my work and said, Breast cancer [for black women] hasn't budged," he says. "Everything we're doing in Chicago—our best efforts at prevention and treatment—have not made a difference."

To bring attention to the problem, Ansell last year teamed with Sinai's Steve Whitman and Jocelyn Hirschman to analyze local data for breast cancer mortality and formulate hypotheses to explain it, which they detailed in an article published in the journal Cancer Causes & Control. But rather than let the article serve as the last word, they decided to go a step further—by trying to do something about the problem. To make any kind of headway, they knew they would need to engage the entire community of care providers, researchers, advocacy groups, and foundations. They also knew they would need to recruit a leader from the local community with the clout, connections, and stature to pull together such a diverse constituency.

They settled on three candidates: Ruth Rothstein, former chief executive of the Cook County Bureau of Health Services and now chair of the board at Rosalind Franklin University of Medicine and Science; Sister Sheila Lyne, CEO of Mercy Hospital and former commissioner of the Chicago Department of Public Health; and Donna Thompson, CEO of Access Community Health Network. Ansell and Whitman hoped one of the three would agree to head the breast cancer task force they envisioned. To their surprise, all three agreed to serve as cochairs, and the task force came together.

Over the course of this past spring and summer, more than 100 doctors, researchers, advocates, and other experts participating in the effort met frequently to address specific areas suspected of contributing to the high rate of mortality among black women. They gathered at night and on weekends, trading countless e-mails and phone calls in between, applying the wisdom of a very smart crowd to a knotty problem. "We have the entire community engaged, from different disciplines, all sitting around the table together," Ansell says. No one has been paid a dime. "All this has been done in a really quick time frame, and it's been a monumental amount of work," says Elizabeth Marcus.

The task force intends to produce a report containing recommendations on the structural and public policy changes that must occur to address the breast cancer problem. "I don't think the solutions will be easy, but they'll be doable," Marcus says. Although the report had not been completed by press time—it is to be unveiled to the public on October 17th—the task force was focusing its attention on three main areas.

• Access to mammography. "Our system is so fragmented," says Ferrans. "Women know about Stroger Hospital, but they don't know they have other options—and options much closer to home—where they can get low-cost or no-cost diagnosis and treatment." They also need to be given greater awareness about federal money available through the Illinois Breast and Cervical Cancer Screening Program, as well as private funding through community and advocacy groups—much of which goes unused and gets returned at the end of each year.
  
  The current system is so confusing that often providers themselves don't know what options are available. "There is a huge disconnect between all of the players," Ferrans says. "One of the things we hope to accomplish is better communication between the providers and the community, and closing some of the huge holes we have in the safety net."
  

 
• Quality of mammography. Women who go for annual mammography screenings can reduce their chances of dying of breast cancer by up to 30 percent. But mammograms are often inconclusive and difficult to read. It helps to have the best equipment, and multiple sets of expert eyes scrutinizing the x-ray for abnormalities—luxuries that strapped clinics serving the poor often go without. "Mammography is a complex thing," says Paula Grabler, a radiologist at Northwestern Memorial Hospital who specializes in breast imaging (she's also the wife of David Ansell). "Anyone can pick up a large tumor. But is the technologist highly skilled to see all the cancers, especially the tiny stuff? Because finding those gives the best chance of survival.
  
  Grabler knows of a local organization providing mammograms to poor women that was catching just two cancers per thousand. The number should have been at least six—meaning it may have been missing four cancers per thousand women. She and others suspect that these numbers point to poorer quality of mammography among some providers, possibly due to a shortage of skilled technicians and radiologists. But because institutions are not required to measure for quality, they don't know for sure. Her hope is to get institutions to start sharing all of their results on a confidential, transparent Web site. The data would be audited—not to point a finger at providers that are falling short but to identify where the problems are and get support to where it's needed.
  

 
• Quality of treatment. Even for those with access to care, the treatment itself may not be up to the standards that people living in more affluent areas enjoy. The group looking into this area would like to identify best practices and establish quality benchmarks that providers around the city would strive to meet—again reporting their results confidentially to pinpoint which institutions are meeting the standards and which need help.

This article appears in the October 2007 issue of Chicago Magazine.

Did you like what you read here? Subscribe to Chicago Magazine »