Running for Love of Women

October 19, 2008 was Race Day in Dallas; Race for the Cure, that is.

I have had friends over the years who have had breast cancer; many have survived and thrive still. Some have died of the disease. Breast cancer has come closest to home in the person of my beloved M., who is a 20-year survivor. I marvel at the stories of what she went through during her two surgeries, with subsequent chemotherapy; and I whisper small grateful prayers for our meeting, and our life together. It so could have been otherwise (and when I think this, I always think of Jane Kenyon's poignant poem of that name, "Otherwise").

Given that I started running this year, and -- much to my surprise and delight -- have stayed with it, and given that my daughter decided to walk with a team of women from the office where she worked this summer, it occurred to me that I could run in the race this year. I've been running five miles at a whack pretty regularly, so I figured a three-mile run was doable.

We got to the race location early, riding transit with many other pink-clad women down to the massively-crowded site; about 25,000 runners and walkers participated in the 25th anniversary Race today.

We walked around for a while, since we got there early; I noticed a strong representation of African-American women; some Latinas were there as well, but it did not seem to me there were a number representative of their overall population in Dallas. That got me wondering ...

And then it was time to run. As a novice, I was one of the few runners clueless enough to start at the back of the pack; the first two miles were bumper-car running through yards, among walkers and strollers, and sometimes on the street where I was supposed to be. About halfway through we ran by a high school, and a bunch of kids were passing out water; I noticed they were mostly Latino/a.

The sweetest moments came in the last mile, as the road opened up for a clear run, down and then uphill, and then around a corner where a high-school group was cheering and clapping. I knew it wasn't personal, but applause and a band playing is rare for those of us who are not playing high school football, so I got a lump in my throat. I noticed the group was all Latino/a kids, too. And then the finish line was in site, and I was looking for my beloved M., who promised to wait for me and watch me cross the line.

It felt great to run across the finish line; it felt even better to see the grin on M's face as she snapped my picture and gave me a big hug. I was thinking about a finish line she crossed 20 years ago, done with surgeries and chemo and learning to live into her survivorhood.

We walked around afterwards, waiting for our teenager to finish, and got to participate in donating to a local tissue bank that is supporting breast health research.

As we walked around, I wondered about the representation of ethnicities among the women involved, and got curious.

When I got home, I Googled up some statistics on breast cancer findings by ethnicity. In a report titled "Trends in Breast Cancer by Race and Ethnicity"*, I read that "The average annual age-adjusted incidence rate from 1996 to 2000 was 140.8 cases per 100,000 among white women, 121.7 among African Americans, 97.2 among Asian Americans/Pacific Islanders, 89.8 in Hispanics, and 58 in American Indians/Alaska Natives."

Although more breast cancers are diagnosed in white women, tumors found in women of color tend to be larger (by the time they are found) and tend to be at later stages, with resulting increases in rates of death. Racial disparities in access to health care, including mammography and other screening and diagnostic services -- particularly for low-income women -- are primarily to blame. Other contributing factors leading to a higher rate of death from breast cancer in women of color include delays between abnormal mammographic findings and definitive diagnosis, more limited access to health characteristics, and variances in follow-up care. For instance, studies have shown African-American women are less likely to have follow-up radiation therapy after surgery.

When treatment protocols are equalized, death rate disparities are substantially less. For instance, "An analysis of the survival experience of women with breast cancer treated in US military health care facilities suggest that the disparity in breast cancer survival between African American and white women could be reduced by 70% by providing
equal treatment to all women."

The study referenced above asserts that "Passage of the Breast and Cervical Cancer Prevention Act of 2000, which states the option to provide medical assistance through Medicaid to eligible women who were screened through the Center for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program, should reduce economic barriers to those who meet the eligibility criteria."

Options ... shoulds ... well. Laws don't always have intended outcomes. What's the funding level? Who qualifies through Medicaid? What about women who don't qualify?

The authors of this study note the truth that much additional research is needed on the causes, prevention, and treatment of breast cancer; but they also note that "much progress can
be made by applying current knowledge fully and equitably to all segments of the population."

Indeed. That's a race I'd like to be helping to win.

* Here's the citation for the journal article that provided the statistics I quoted: CA Cancer J Clin 2003; 53:342. Asma Ghafoor, MPH, Ahmedin Jemal, DVM, PhD, Elizabeth Ward, PhD, Vilma Cokkinides, PhD, MSPH, Robert Smith, PhD and Michael Thun, MD, MS