Battling Breast Cancer
Black women at risk
June 12, 2000 -- In Faith Fancher's house, high in the hills above San Francisco Bay, her cat Lazarus tiptoes around the living room. Here and there, framed photographs testify to Faith's 27 years as an award-winning TV news reporter.
As in television, each picture tells a story: There's Faith, smiling as she wins a journalism award. There's Faith, tanned and glowing during a trip to Mexico. There's Faith in a black halter dress, looking just like Whitney Houston with her tousled hair and red lipstick.
But look at Faith Fancher herself today, and you see a different woman.
The woman in the photographs is bald now, curled up on the sofa with Lazarus and wearing an old pair of blue sweatpants. Her hair is gone, all of it, even her eyebrows. "I haven't shaved in eight months," says Fancher, laughing ruefully. "I look like a peeled egg."
Like her tousled hair in the photo (actually a wig), Fancher's slinky halter was also an illusion, carefully fitted to hide her port, a plastic tube surgically inserted into her chest through which chemotherapy drugs drip into her bloodstream. Only the red lipstick remains, a vivid reminder that Fancher, 49, is very much alive despite two bouts with breast cancer.
Diagnosed in 1997, Fancher had a mastectomy. Then last June, she found "a little pimple" in her reconstructed breast, in which a small amount of tissue had been allowed to remain. It was cancerous; Fancher had a lumpectomy, chemotherapy, and radiation, which left her too weak to work or even putter in her garden.
Yet she continues to make the rounds of luncheons and fund-raisers, fired by a simple fact that she repeats again and again: While black women are less likely than white women to get breast cancer, they are much more likely to die from it.
"It knocked me for a loop," says Fancher, who spends much of her time now lobbying for more money for early-detection programs, including mammography and breast self-exam. "I mean, my first thought was, why are we dying?"
Why, indeed. A study by National Cancer Institute (NCI) researchers, published in the journal Archives of Family Medicine in November 1999, revealed an alarming increase in the already troubling gap between black and white mortality rates due to breast cancer, from 16% in 1990 to 29% in 1995. And the NCI data show that the five-year survival rate for black women with breast cancer is 71%, compared with 87% for white women.
Experts have traditionally explained the discrepancy between black and white survival rates by noting that black women tend not to seek help until their cancers are already at an advanced stage. But the authors of the NCI report found that mortality among black women during the 1960s and 1970s was actually lower compared with that of whites until 1981, when mortality for whites began to drop sharply in response to more aggressive screening programs and better chemotherapy protocols.
And that leads to a disturbing conclusion, says Otis Brawley, MD, one of the study's authors: That black women have somehow been cheated out of the advances that have taken place over the past 20 years in mammography, chemotherapy, and powerhouse drugs such as tamoxifen.
Brawley blames poor access to health care and lower standards of care for black women. "While we have evidence that equal treatment yields equal outcomes, we also have evidence that in breast cancer there is not equal treatment," says Brawley, who is also head of the NCI's Office of Special Populations. "A lot of black women do not get nearly as good treatment for breast cancer as do white women."
One problem is screening: Despite steady increases in mammography use by black women during the 1980s and 1990s, an article in the Journal of the National Cancer Institute in March 2000 said that black women are still less likely than white women to have access to low-cost screening programs where they live.
But others point to a possible genetic cause. "When you look at the biology of the tumors that are often found in African-American women, the tumors are a little bit more aggressive, and the cell types are much more atypical than (those of) the average white woman," says Charles J. McDonald, MD, a cancer specialist and immediate past president of the American Cancer Society (ACS). Heredity also appears to play a role in why black women get cancer at a younger age, he says.
According to NCI data, black women are more likely to be diagnosed with cancer before they are 40, when cancers are most aggressive; more likely to be diagnosed at an advanced stage; and less likely to survive five years after diagnosis. Clinical studies report that black women also are up to twice as likely to be diagnosed with breast cancers that are estrogen-receptor (ER) negative, meaning they resist popular estrogen-blocking drugs, such as tamoxifen, which work by starving ER-positive tumors of the hormone they need to grow.