And Then You Die!

The headline from US News & World Report reminds of the old joke that ends with that punchline. Unfortunately when you're old, poor, Black and female it's no joke. It's no joking matter. You're the most neediest among of us, you're the most disadvantaged among us, you're the most discriminated among us, you're the most abused among us and when you marry if you get terminally ill your mate will leave you to die. Even if they don't you're the most likely to, if you have cancer, not survive when others would have.

The one headline lead us to the Journal of Cancer study we could not find but to many other studies in the journal from the US, Mexico and Switzerland. The studies relating cancer to issues of color, discrimination and poverty. Here is what we came upon in our verification process:

African-American women have increased breast cancer mortality compared with white women. Diagnostic and treatment gaps may contribute to this disparity.
Disparities in medical care among patients with newly diagnosed breast cancer were evident between African-American women and white women despite health plan insurance coverage. Interventions that address the gaps identified are needed. Cancer Journal

Racial differences in follow-up of abnormal mammography findings among economically disadvantaged women
BACKGROUND: In the United States, and particularly in South Carolina, African-American women suffer disproportionately higher mortality rates from breast cancer than European-American women. The timeliness of patient adherence to the follow-up of mammographic abnormalities may influence prognosis and survival. The objective of the current investigation was to examine racial differences in the completion and completion time of a diagnostic workup after the finding of a suspicious breast abnormality.
CONCLUSIONS: The results from this study established a racial disparity in the time to completion of a diagnostic workup among Best Chance Network participants. These findings highlight the importance of understanding the factors associated with delays in and adherence to completing the recommended workup when breast abnormalities are detected in mammograms. Cancer Journal

Ethnic disparity in mortality after diagnosis of colorectal cancer among inner city minority New Yorkers
CONCLUSIONS: The first to compare inner city minority subjects with CRC, the authors observed increased odds of death in AAs, despite similar clinical features and living environment. Tumor behavior or host response among AAs could explain this difference. Aggressive therapeutic and early detection strategies need to be tested in a large randomized study setting to substantiate our study findings. Cancer 2009.

Impact of socioeconomic status on prostate cancer diagnosis, treatment, and prognosis in Geneva, Switzerland, in which healthcare costs, medical coverage, and life expectancy are considered to be among the highest in the world.
CONCLUSIONS: In the current study, patients of low socioeconomic class were found to be at increased risk of dying as a result of their prostate cancer. This increased mortality is largely attributable to delayed diagnosis, poor diagnostic workup, and less invasive treatments in these individuals. Cancer 2009.

Prejudice against blacks is becoming unacceptable although it will take years to eliminate it. But it is doomed because, slowly, white America is beginning to admit that it exists. Prejudice against women is still acceptable. - Shirley Chisholm

The impact of Medicaid coverage and reimbursement on access to diagnostic mammography
CONCLUSIONS: Callers with Medicaid were offered appointments for DM less frequently than callers with Medicare, although both were widely accepted. State Medicaid reimbursement rates did not affect access to mammography. Cancer 2009.

Racial differences in treatment and outcomes among patients with early stage bladder cancer
BACKGROUND: Black patients are at greater of risk of death from bladder cancer than white patients. Potential explanations for this disparity include a more aggressive phenotype and delays in diagnosis resulting in higher stage disease. Alternatively, black patients may receive a lower quality of care, which may explain this difference.
CONCLUSIONS: Although differences in initial treatment were evident, they did not appear to be systematic and had unclear clinical significance. Whereas black patients are at greater risk of death, this disparity did not appear to be caused by differences in the intensity or quality of care provided. Cancer 2009.

WHO calls for action beyond the health sector to improve the health of girls and women
Despite progress, societies continue to fail women at key times
Despite considerable progress in the past decades, societies continue to fail to meet the health care needs of women at key moments of their lives, particularly in their adolescent years and in older age, a WHO report has found.

It was this final study that gave us considerable cause for concern. This was the most disheartening of all and unfortunately the full information was not available to us or you. Our only solace is that we in our lives are not making it true. For the unlucky/unblessed/unfortunate among us it is a sad reality that speaks to the real state of the nation. Reuters news service printed this story:

Men more likely than women to leave partner with cancer
The study confirmed earlier research of a divorce or separation rate among cancer patients of 11.6 percent, similar to the general population, but found the rate jumped to 20.8 percent when the woman was sick versus 2.9 percent when the man was ill.

"Female gender was the strongest predictor of separation or divorce in each of the patient groups we studied," said Marc Chamberlain, director of the neuro-oncology program at the Seattle Cancer Care Alliance (SCCA).

The researchers said the reason men leave a sick spouse can be partly explained by their inability to rapidly adjust to becoming a caregiver and to look after the home and family.

The picture of the elderly woman above was the last time we saw our namesake in her chair. It was taken just before she was admitted to the hospital for one of her last visits. When we brought her we did not know she would not be coming home ever again. We never know when the last time will be the last time. What comforts us now is the words of our family which said: "Think how better her life was with you in it!" Too many women are old and alone without anyone to care for or to care for them. Pearlie Mae Leach Frierson outlived her husband and son until there was just us. That we had her brings us continued joy.