In December 2013, the New York Times turned its spotlight on Memphis, Tenn., laying bare the story of a community where some combination of poverty, limited access to health care, cultural barriers, fear and superstition combines to create the largest racial breast-cancer-survival gap in the entire country.
In Memphis between 2005 and 2007, the period during which a Chicago-based Sinai Urban Health Institute study examined the racial survival gap (pdf), the white breast-cancer death rate sat around 21 percent. By comparison, about 45 percent of black women (pdf) diagnosed with the disease in Memphis died. Across the country, black women are 40 percent less likely than their white counterparts to survive, according to National Cancer Institute data.
The same year Fields made her discovery, over the holiday season she watched her breast continue to swell. It grew warm to the touch. The texture of her nipple took on the quality of pebbled leather, and a thick layer of skin at the bottom of her breast began to protrude. By the time she was able to get an appointment with her doctor early the next year—a meeting during which she had initially planned to discuss her post-wedding plans to conceive—her doctor was alarmed. And a few days later she received the diagnosis: stage 3, inflammatory breast cancer. Stage 4 is often terminal.
“Of course I wondered, ‘Why is this happening to me?’ I believe in karma,” Fields says, “so, it was like, ‘What did I do to deserve this?’ I’m barely 30. I wasn’t prepared to die.”
Because the racial survival gap is a problem so acute and seemingly intractable—it has widened since the 1970s—some women’s health-advocacy organizations have begun to describe it not only as a medical issue but as a pressing social-justice issue as well.
And earlier this month, U.S. Department of Health and Human Services Secretary Kathleen Sebelius unveiled a policy change heralded by the Susan G. Komen Foundation—the nation’s largest private nonprofit raising funds for breast-cancer research—as part of the effort to reduce breast cancer’s annual human toll, some 40,000 lives.
Under the terms of the Affordable Care Act, better known as Obamacare, health insurance companies will now be required to provide access to women at high risk of breast cancer, free of charge, to a pair of drugs that Sebelius described as capable of preventing some from developing the disease.
However, the types of fast-growing and often virulent forms of cancer more common among black women and younger women of all races—inflammatory and triple-negative breast cancers—don’t adequately respond to these drugs, so when it comes to narrowing the racial survival gap, the change isn’t likely to be a game changer.
“Any opportunities to make a drug readily available is an important gain for women’s health,” says Valerie Rochester, director of programs and training at the Washington, D.C.-based Black Women’s Health Imperative. “However, as wonderful as this news is, for many black women—the group most likely to die from this disease—there will be no benefit.”
That’s a difficult projection, given the politics around Obamacare and what many women and minority health care advocates, including the women at the Black Women’s Health Imperative, say the Affordable Care Act will do to narrow a myriad of racial health disparities. The HHS announcement, according to three women’s health-advocacy organizations contacted by The Root, will have little impact on the long and rarely explored list of reasons that a disproportionate share of black women continue to die.