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Smoking Gap Between Blacks and Whites Still Too Large
By: Hazel Trice Edney
NNPA Washington Correspondent
Originally posted 5/3/2006

WASHINGTON (NNPA) - Cigarette smoking and lung cancer mortality rates overall are declining in the U. S., but lung cancer death disparities between the races - Blacks and Whites - remain alarming, leading health care and anti-smoking experts say.
“We haven't closed the gap.

While everybody's improving, the gap is not closing. The five-year survival difference is still in the range of 10 to 15 percent for Blacks and Whites. So while it's an improvement for all groups, the difference or the disparity remains,” says Dr. Harold Freeman, a respected surgical oncologist and director and founder of Harlem's Ralph Lauren Cancer Center for Cancer Care and Prevention. He explains, “It's like you have the front wheels and back wheels of a car, but no matter how fast you go, the back wheels are never going to catch up.”

The association of state attorneys general reported in March that data derived from federal government tax collections shows a 4.2 percent decline in cigarette sales last year and a drop of 20 percent since the attorneys general reached a legal settlement with tobacco companies in 1998.

Anti-tobacco activist Sherry Watson-Hyde, executive director of the National African American Tobacco Prevention Network, is happy that the rates have declined for African-American smoking, though not deeply enough.

“Black male lung cancer rates have been over the top,” Watson-Hyde says. Even with the state tobacco settlements, she said the tobacco industry still finds new ways to ensnare smokers with flavored cigarettes special promotions.

The NAATPRN and other anti-tobacco organizations, such as the American Legacy Foundation, which has awarded a three-year grant of $4.5 million to a coalition of six national Black organizations, including the National Newspaper Publishers Association Foundation, for tobacco prevention and cessation programs, focus largely on reverse marketing by educating African-Americans on the dangers of tobacco smoke.

The Center for Disease Control and Prevention reports that while the annual White lung cancer death rate is approximately 58 percent per 100,000 diagnoses, the rate for Blacks is 64 percent per 100,000. Cancer experts say the rates have remained consistently disparate - within the 15 percentile over the past two decades - even when fluctuating. Black and White women are about the same at 40 percent for Black women and 42 for White.
Tobacco use is the major cause of lung cancer in the United States.

About 90 percent of lung cancer deaths in men and nearly 80 percent of lung cancer deaths in women in the U. S. are due to smoking. Why are Black men dying of lung cancer at such higher rates? And what is being done about it?

Freeman believes race play a role.

“Race is a determinant in how people get treated for cancer even when they're at the same economic status; not just lung cancer, but in general,” he says. “The biggest challenge in America for disparities is to get standard treatment for everybody, to make it available somehow.”

He says that unless a system is created that targets people's ability to get early medical intervention regardless of their ability to pay, the disparities will remain. A publicly funded “patient navigation” program that he started 16 years ago for breast cancer patients should be a model for the nation for all types of cancer, he says. The public program pays for breast cancer screening for women regardless of their socio-economic status.

“I improved the five-year survival rate at Harlem Hospital from 39 percent to 70 percent for breast cancer in poor Black women,” he says. “They remained poor. They remained Black. We didn't change that. But I changed what we did for them.”

Some say that the belief by some African-Americans' that surgery contributes to the death of cancer patients may be contributing to high cancer death rates. Doctors say surgery for lung cancer is the most effective curative procedure.

But a report by the American Lung Association states: “One possible reason African- Americans are less likely to have surgery is a belief that air exposure during lung cancer surgery might cause the tumor to spread.

A 2003 report published in the Annals of Internal Medicine - “Racial Differences Pertaining to a Belief about Lung Cancer Surgery: Results of a Multi-Center Survey” - that supports this view.

“A recent study found that 19 percent of African-American lung cancer patients at the Philadelphia VA Medical Center stated that this belief was a reason for opposing surgery, and 14 percent would not accept their physician's assurance that lung cancer surgery does not have this effect. Several of these African-American patients asserted that this belief was common in the African-American community.”

Another debate is over why Blacks are not participating in clinical trials that often prolong the lives of lung cancer patients.
A wide-held perception has been that Blacks are skeptical of clinical trials and decline to participate in them because of the 1932 Tuskegee syphilis study in which the U. S. government intentionally left 200 African-American men untreated for the crippling disease.

But a study by the National Institute of Health released early this year, said a survey of 17,000 Americans, 14,000 of which were Blacks and Hispanics, concluded that - despite some known distrusts of the health care system - Blacks with lung and other types of cancer are just as likely as Whites to participate in curative research trials. It concluded that they just don't because they're not asked.

Julia Rowland, director of the office of Cancer Survivorship at the National Cancer Institute agrees that Blacks are invited to participate in studies, but may have other variables that block their following through.
“It's not because they're not invited. It's because there may not be studies [medically] appropriate for them,” she says.

“When we think about clinical trial participation, you have to think about the nature of someone's disease and whether there's actually a trial available for them and then whether or not they have the eligibility critieria. For example, if you have a rare disease or have a serious heart condition, you may not be eligible, or you may not live near a center that's delivering that interview.”

Freeman says regardless of the reason that they don't, it would be more helpful if more Blacks were to participate in clinical trials.

He says he has seen as much as a 12 percent difference in favor of White people who had early stages of lung cancer getting curative treatment, which is surgery, compared to Blacks.

“At a minimal, people who participate in clinical trials get better treatment,” he says. “We need to find a way to ask them in that is acceptable to them because people are different culturally.”

Because more than half of cancers are caused by lifestyles, African-Americans, can cut their own death rate by simply taking better care of themselves, Freeman stresses.

Regular check ups and a prudent diet, high in fiber, vegetables and fruits and low in animal fat are among the most important lifesavers, he says. And because a third of cancer deaths are due to smoking and tobacco used has been cited as a contributor to at least 15 types of cancer, he says one word could make the difference between life and death: “Quit.”

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