By Anna Miller
Some people tell Rep. Debbie Wasserman Schultz (D-Fla.) that she is lucky to be alive.
But Ms. Wasserman Schultz, who battled a particularly lethal type of breast cancer, attributes her survival to more than luck.
“While I was certainly fortunate to have access to good health care, I didn’t find my tumor early because of luck," she said last Thursday at the Eliminating Breast Cancer Health Disparities: Communicating to At-Risk Populations symposium at GW’s Jack Morton Auditorium. “I found my tumor early because of awareness and education.”
As the event's keynote speaker, Ms. Wasserman Schultz used her personal experience to underscore the importance of both knowledge and access to care in the fight against breast cancer. The symposium, which was hosted by GW’s Medical Center and Medical Faculty Associates, the Avon Foundation for Women and Friends of Cancer Research, explored how cancer centers, community health centers, advocacy organizations, and government agencies can improve communication with underserved populations in order to eliminate breast cancer disparities.
Although breast cancer, which affects one in eight American women, does not discriminate, the disease is more prevalent in certain populations. For instance, white women are more likely to be diagnosed with breast cancer, but black women are more likely to die from it. Additionally, an aggressive and difficult-to-treat type of cancer called "triple negative" is more prevalent in African American, Hispanic, and pre-menopausal women. Because these disparities are attributable to both biological differences and societal barriers to care, the symposium’s panelists argued that a multifaceted solution is needed.
“Across the university, we are conducting research on issues related to [breast cancer], including in the basic sciences, clinical medicine and public health,” said GW President Steven Knapp in his opening remarks. “Much of our work is focused directly on our community here in Washington, D.C. where the mortality rates from breast, prostate and colorectal cancer are among the highest in the nation.”
The symposium featured a panel of local and national breast cancer advocates led by Rachel Brem, director of the Breast Imaging and Intervention Center at GWUMC. The panel included Christopher Masi, assistant professor of medicine at the University of Chicago; Steven Taplin of the Division of Cancer Control and Population Sciences at the National Cancer Institute; Tesha Coleman program director of clinical services at the Capital Breast Care Center; and Marc Hurlbert, director of the Avon Foundation Breast Cancer Crusade.
The panelists underscored the importance of boosting minority participation in research studies in order to better treat the most vulnerable populations. But according to Dr. Masi, there is a pervasive mistrust of the federal government and the medical community among minority communities, which can deter recruitment.
“We need more minority physicians," he said. “These individuals will hold a lot more credibility in different groups in terms of encouraging them to be a part of clinical trials.”
The Avon Foundation is also helping to increase enrollment numbers through its new program called "Army of Women," a database of healthy female volunteers. By connecting researchers with potential subjects, the program strives to accelerate cancer research, said Dr. Hulbert.
“The key is to really educate the public and engage them in the clinical research process, ” he said.
Cancer disparities are not only biological, the panelists emphasized. Access to care – both physically and financially – greatly affects individuals' likelihood of receiving timely and effective screening, diagnosis and treatment. According to Ms. Coleman, one effective method for improving access among underserved populations is the use of patient navigators, or trained guides who assist people through the cancer care continuum.
Insurance status was also recognized as a key factor determining whether or not women seek screening and receive appropriate care. However, the implementation of the Patient Protection and Affordable Care Act will help address this issue, said Ms. Wasserman Schultz.
“Health care reform is a giant leap forward in eliminating health care disparities,” she said.
Finally, the symposium examined the impact of the fall 2009 United States Preventive Services Task Force recommendation against both routine mammograms for women under age 50 and breast self-examination. Because the decision countered previous recommendations and those of other health organizations, the speakers agreed that information dissemination is more important than ever before.
“If there is one message here, it's that there are multiple messages,” said Dr. Brem. “We have to work collaboratively with research, education and community health services in order to really optimize the care for all women.”