Black, Hispanic Chicago Women Less Likely To Be Referred To Top-Tier Centers For Mammograms
Where women get their mammograms matter.
An article published in the Chicago Tribune says;
“In Chicago, black women are more likely than white women to be diagnosed with breast cancer when the disease is at a late stage, making it more difficult to treat. Black and Hispanic Chicago women are less likely than white women to get diagnosed with breast cancer early, when the illness is more treatable, in part because racial minorities are less likely to be diagnosed at high-performing centers of excellence in breast cancer care, according to a new study by researchers at the University of Illinois at Chicago.”
This is not an old article. It was published on January 3, 2019. I do not live in Chicago but experienced how difficult it is to get a mammogram and even more difficult to get aspirations and biopsy.
Until last year whenever I called for an appointment, I was given an appointment with no questions asked. My primary physician’s office is located in a medical center. In the same center is a Prompt Care facility, a Women’s Center, labs, and diagnostic equipment. However, when I phoned last year to schedule a mammogram I was asked if I had previous issues. When I answered “yes”, I was told that I needed a diagnostic mammogram that was only given with a doctor’s order, and only at the Women’s Center located in the hospital. No problem.
I called my primary physician’s office. There, I was helped by someone other than my physician or his nurse and was instructed that if I was having issues to go to Prompt Care because my physician did not have an available opening until three days later.
I went to Prompt Care and the physician examined me and wrote up the order for a diagnostic mammogram. Then I waited to be contacted by the Women’s Center for an appointment. That didn’t happen.
When I did see my primary care physician, he said that the Women’s Center does not call and I would need to call them. There was also confusion on whether a physician other than my primary physician could issue the order for a diagnostic mammogram. My physician did write-up and submit another order. It was a late Friday which meant I could not call the Women’s Center at the hospital for an appointment until Monday.
I get it. The idea is to get patients the RIGHT type of mammogram; however, by not explaining the procedure, and if progressive cancer is present, the delay might not identify the cancer in its early stages.
Subsequently, I did have the diagnostic mammogram and an ultra sound. Having the ultra sound was a procedure I had come to expect going back to 2007 even without a diagnostic mammogram so, it came with no concerns on my part. A nurse then met with me and scheduled aspirations and a biopsy. She did not tell me that the mammogram showed malignancy. Being cystic since 1995 and having numerous aspirations and biopsies throughout the years, it was routine for me. I received confirmation from the hospital that both procedures were scheduled, and also confirmed with my insurance company that both procedures were pre-authorized.
When I arrived for the procedures, a man who the nurses referred to as a doctor (who I won’t name in this post) stated to me that all he does are biopsies. A nurse co-signed him by saying the Women’s Center does not perform aspirations. He refused to perform the aspirations and bluntly instructed the nurse to enter on my medical record that I refused the biopsy.
Until then, I felt that I was dealing with procedural changes but the way the doctor spoke along with his refusal to perform the procedures as pre-approved by my insurance company AND confirmed by the hospital, caused me to think differently. Without knowing me, he clearly had something personally against me. My suspicion was confirmed in late October when I saw his September 10, 2018 report on my medical record. That doctor wrote intentional I said, she said lies. According to his report, I was a deranged, angry woman who wanted to be placed under general anesthesia and who asked for medication for a mental problem. In late October 2018, I then realized that the doctor’s report on my medical record was why since September 10, 2018, I had been asked nonsensical questions by hospital staff.
As I worked through the hospital’s system to find a person in charge, one person decided to take it on herself to talk to my primary physician for a referral to a surgeon. I wondered why she suggested to me that I needed to be placed under general anesthesia for a biopsy. This was not my first rodeo but rather than go through it all with her, I told her that I would make an appointment with the surgeon. The way I figured it, I could speak with the surgeon. I discovered when reading the Women’s Center’s doctor’s report on my medical record that it was his lie that I wanted to be placed under general anesthesia that prompted the woman staff member to say what she did.
(As a side note, I refuted that nasty doctor’s report on my medical record and requested amending. In spite of having documented evidence that I was to receive two procedures, and a running list of phone calls to speak to others in charge and a letter so that the procedures would be performed, the hospital recently responded to my request to amend my medical record. They denied it.)
When I met with the surgeon, his first statement to me was that he understood I refused the biopsy. That gave me opportunity to explain to him what really happened in the Women’s Center. He entered the same order as the previous order and I was sent back to the Women’s Center for aspirations and biopsy. Both were performed by another doctor.
But, but, but, they told me that the Women’s Center does not perform aspirations. That lie is a real betrayal of trust.
What this resulted in was a two-week delay for the biopsy result. That delay also resulted in my not being able to have a port catheter before my first chemo treatment. Receiving six and a half hours of chemo directly into a vein, a chemo drug leaked and caused a nightmare of complications. A week ago when I went for post-surgery follow-up and was told the pathologist’s report, I realized that the leak gave me a testimony. I’ll blog about that later.
According to the Chicago Tribune;
“The study of 989 patients found that 35 percent of white patients were diagnosed at a relatively late stage, compared with 47 percent of black patients and 53 percent of Hispanic patients.
Statistical analysis found that one of the main factors accounting for the disparity was whether the patient was diagnosed at a Breast Imaging Center of Excellence (BICOE) accredited by the American College of Radiology. While 81 percent of white patients were diagnosed at a BICOE facility, only 46 percent of black patients and 49 percent of Hispanic patients were.”
The study was published online in the journal Cancer Epidemiology, Biomarkers and Prevention in October. It elaborates a previous study by one of the authors and makes it more comprehensive.
I would like to point out that there might be a significant difference in the cost of equipment as one reason why BICOE’s are not located in all facilities that perform mammograms. Along with pointing this out, it appears that the best equipment is located in areas where the population is mainly Caucasian.
The article goes on to say;
“Until about 1996, there was no racial disparity in breast cancer mortality, Warnecke said. But as methods of detection improved, white people benefited, resulting in a decline in the white breast cancer mortality rate, while other populations didn’t get access to improvements.”
The Tribune article says that today, Black women are 48 percent more likely to die of breast cancer than whites, both nationally and in Chicago.
There is some good news. Breast Cancer News reports;
“Researchers at the California Institute of Technology (Caltech) developed a new imaging technology that scans the whole breast to spot possible tumors in about 15 seconds, providing detailed images without the need to painfully compress the breast, as happens in mammograms. The approach – called single-breath-hold photoacoustic computed tomography (SBH-PACT) – shines pulses of near-infrared light into the breast and may one day replace mammograms as the standard method for diagnosing breast cancer.”
It would be good for women to have mammograms that don’t cause pain and bruising. It would be even better if insurance companies did not charge co-pays for aspirations and biopsies.