'A Civil Rights Issue'
By Rich McManus
On a day when it had to compete not only with a fly-by from astronaut/politician John Glenn, but also a snowstorm and the absence of a keynote speaker, a symposium on cancer in the Black community drew only a handful of participants to Natcher auditorium Jan. 8. But the few who came got a top-flight review of cancer's inroads in medically underserved populations by a panel of gifted speakers.
Ironically, the most-anticipated voice on the panel did not show up. Former congressman Kweisi Mfume, who is now president of the National Association for the Advancement of Colored People, had been scheduled to give the keynote address, but sent his top health staffer instead. Caya B. Lewis, the first full-time health expert at NAACP headquarters, said Mfume is "very serious about health issues affecting African Americans. Health, at its base core, is a civil rights issue."
NAACP's Caya B. Lewis
She outlined three areas of focus for the organization which, founded in 1909, is the nation's oldest and largest civil rights group: HIV/AIDS, hypertension (high blood pressure), and cancer.
"Fifty-seven percent of new cases of HIV infection are reported in minorities," Lewis said. "It has become a disease of people of color." She said that last July's national NAACP convention in Atlanta featured a march titled "Outrage Over AIDS" to draw attention to the disease's ravages in Black communities. "Sixty-three percent of new cases of HIV infection in adolescents occur in African Americans," she said. "I don't know why we haven't been screaming louder about (these statistics) before." She said a state of emergency exists in the Black community, and that NAACP will respond with AIDS prevention programs aimed primarily at young people.
Regarding hypertension, Lewis said stroke was the nation's top killer of African Americans, and added that NAACP will collaborate with such voluntary agencies as the National Kidney Foundation and the National Stroke Association to get the word out on reducing high blood pressure among Blacks.
When Lewis came to the topic of cancer, she lowered her voice dramatically. "For years, people kind of whispered the word -- cancer. Thank God some of us can talk a little bit louder about it today. We whispered because it used to be a death sentence. It was scary, and there was nothing you could do about it. Well, I'm thankful we don't have to whisper anymore. Thank goodness for mammography. Thank goodness for radiation therapy. Thank goodness for tamoxifen, and the PSA (prostate specific antigen -- a sentinel of prostate cancer) test.
"Cancer is still striking African Americans disproportionately," Lewis said. "The mortality rate and incidence rate of prostate cancer are the highest in the whole world among African American men. We're advocating that minorities get involved on every level of treatment development, training and research on cancer. We want to see increased cancer research funding overall -- but especially for the cancers that disproportionately affect African Americans. We need to send more effective prevention messages.
"African American physicians tend to have African American patients -- they are more comfortable going to see them," she explained.
She concluded, "Cancer is something that we must attack, it's something we must continue to address, and it's killing our families in ways that it shouldn't. People aren't finding out early enough that they have cancer of various kinds." She urged physicians-to-be in the audience not to view the downtrodden in society as problem people, but rather as people with problems.
Sponsored by NCI and the American Cancer Society, the daylong program, titled "Cancer in the African American Community: Addressing the Medically Underserved" was organized by the Student National Medical Association, the preprofessional arm of the nation's largest minority medical society, the National Medical Association.
Panelists, who included survivors as well as clinicians, explored cancers of the breast, colon, lung and prostate, which "are the major cancer killers in the U.S. -- they constitute the majority of cancer deaths in this country," said Dr. Gabriel Feldman, director of prostate and colon cancer for the American Cancer Society.
Cancer surgeon Dr. Robert DeWitty of Howard University gave a particularly engaging talk on his breast cancer practice, which draws some 175 women a week to his office downtown. Some 98 percent of his patients have concerns about their breasts. "Breast cancer engenders a lot of fear and anxiety, but the reality is that most women still don't get breast cancer. Breast pain and breast cancer are usually not related," he continued. "Most breast masses are not cancer either." Emphasizing the importance of early diagnosis, he ran through a series of slides depicting new technologies -- stereotactic biopsy, and infrared heat-sensing devices ("Cancer tissue has a different heat pattern than regular breast tissue") -- adapted largely from Defense Department weapons research ("Some of the same technology the Army used to lob those bombs during the Persian Gulf war went into this stuff," he recounted.)
He urged women to do a simple, 3-second breast self-exam in the shower each morning, and to learn their own bodies the way they know their own kitchens. "You could probably blindfold yourself and find your way around your own kitchen well enough to make a meal," he said. Why not know your own body as thoroughly?, he challenged.
Dr. Debra Saslow, director of breast and cervical cancer for the American Cancer Society, said the incidence of breast cancer is actually higher in white women than in Blacks, but that the mortality rate is higher in Black women. Around 5 or 6 more Black women than whites per 100,000 die of the disease. The average woman's breast cancer risk at age 25 is 1 in 14,493, then rises with age to 1 in 230 at age 40, and finally 1 in 8 at age 80. The ACS recommends annual mammography for women, beginning at age 40, and monthly self-exams starting at age 20. The good news in the African American community, Saslow said, is that screening rates are up for Black women. "There has been a dramatic rise in the number of African Americans getting mammographies and clinical breast exams," she said. "And as a result, breast cancer mortality and incidence rates in this population are starting to come down."
Interestingly, there are biological differences in breast cancer in different cultural groups, Saslow reported.
Another bit of hopeful news was delivered by Dr. Otis Brawley, director of special populations research at NCI, in opening remarks to the medical students. Acknowledging "an extreme shortage of minority individuals on the scientific staff at NIH (he said he's one of only 4 tenured Black investigators here)," owing to a dearth of minority medical school applicants, there are, nonetheless, "quite a few well-paid fellowships available at NIH."
Brawley exemplifies the path he urged the audience to take: he came to NCI's endocrinology section while he was a fourth-year medical student -- and SNMA member -- at the University of Chicago and is now an expert in the design of medical trials, chiefly those recruiting socially disadvantaged patients.
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