Although cardiovascular disease is the number one cause of death for both blacks and whites, nothing provokes as much anxiety as the fear of cancer. Over the years, I have found patients to be somewhat more compliant with recommendations if they believe it will decrease their likelihood of developing some dreaded malignancy, even though they are more likely to die from heart disease. April 15-21 is National Minority Cancer Awareness Week. Therefore, I thought we should spend a little time discussing a few familiar and not so familiar cancers that affect African Americans.
When was the last time you used sunscreen? So many people of color are unaware that even they need to use some type of protection from the sun on their skin. Although, skin cancers are more commonly found in whites, it is not unheard of in blacks. The great reggae legend Bob Marley actually died of metastatic melanoma which initially started as a lesion underneath his nail bed. Only half of the melanomas found in African Americans are found at an early stage. Therefore patients and healthcare providers alike need to be vigilant about assessing the “ABCD’s” of skin lesions: is the lesion asymmetrical, are the borders irregular, does the lesion have various shades of color, and is the lesion getting bigger (diameter). When in doubt, consult your provider.
One of my favorite gifts to give my patients for their 50th birthday is a referral for a colonoscopy. I’m sure they were expecting something a little more elaborate but what better gift than one that could potentially be lifesaving. Colorectal cancer is the third most common cancer in men and women in theUnited States and is most often found in people over the age of 50. Per the CDC, Centers for Disease Control, if everyone 50 or older had regular screening tests, as many as 60% of deaths from colorectal cancers could be prevented. Furthermore, if you had a first degree relative with colon cancer you would need to be screened earlier than the general recommendation.
“Save the Ta Ta’s” is the new politically incorrect slogan for some breast cancer awareness t-shirts I’ve seen recently worn by younger women. Because of organizations like Susan G. Komen and its yearly Race to Cure events, knowledge regarding breast cancer and screening recommendations has definitely improved over the last decade. Breast cancer is the most commonly diagnosed form of cancer in American women. Because African American women are diagnosed with breast cancer at much later stages of the disease, the breast cancer death rate is 41% higher in black women as compared to whites even though the incidence of breast cancer is lower.
Studies have shown that mammography (breast x-ray) is used much less frequently in black women than whites and the mammograms are not performed on a standard routine schedule like in whites. There are several well documented healthcare disparities in regards to breast cancer. For example, studies have found that once black women have an abnormal mammogram, her diagnosis is more likely to be delayed unlike white women. In addition, the most difficult to treat subtype of breast cancer, triple negative, is the one more commonly found in black women. Disparities are also seen in the type of treatment received by black and white women. Within 30 days of diagnosis, white women are more likely to begin treatment.
Depending on which national organization you consult, mammograms should be performed yearly beginning at age 40. Women with a first degree relative with breast cancer should be screened sooner. The United States Preventative Task Force is now recommending against women doing self-breast exams but most other organizations continue this recommendation. I personally see no harm in women being familiar with their bodies and alert to changes such as a mass, bloody nipple discharge, or dimpling of the skin. If such changes are found, contact your provider immediately.
There has also been a lot of discussion recently regarding the PSA test and should we be performing such tests in men. The USPTF actually recommends against checking this test because they report that men were undergoing too many invasive procedures for such a slow growing cancer. Many physicians, particularly those that care for African American men, are skeptical of those recommendations. African American men are more likely to be diagnosed at advanced stages of prostate cancer.The current recommendation states that providers should be discussing with men the option to have the test or not. In my practice, we talk about the recommendation but I strongly encourage the patient to consider the test and the rectal exam.
Therefore, this month I encourage you to discuss with your doctor which screening tests are appropriate for you. In regards to cancer prevention, you must deliberately be proactive.
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
