Black Cancer Matters – Susan Gubar, The New York Times

I started following Susan Gubar’s columns during my cancer journey and continue to find them interesting. This column is no exception with its focus on how African Americans are disproportionately affected by cancer with higher mortality rates:

Like many people, I attribute my cancer to bad luck. So the feature-length documentary “Company Town” shocked me. It contends that the economic consequences of racial discrimination increase cancer risk. Watching the movie led me to realize that wretched statistics on cancer mortalities are also linked to racial inequalities. Black cancer should matter, but has it mattered in the past and will it matter in the future?

Company Town,” released in 2016 and available March 20 on iTunes, was co-directed by Natalie Kottke-Masocco and Erica Sardarian. It opens with gospel vocalists singing the words “run down to the river,” a deeply ironic injunction in Crossett, Ark., a setting where a Georgia-Pacific paper and chemical plant — owned by the billionaire Koch brothers — stands accused of polluting local waters. The movie depicts rural people dependent for a livelihood on an industry that they believe is sickening them by contaminating their environment. Most of the men and women dealing with cancer in the area are African-Americans.

We see David Bouie, a Baptist minister who worked in the facility for 10 years, pointing out the houses on his lane. “It’s all around us … cancer, cancer,” he says. “Door-to-door cancer.”

It is difficult to establish a causal connection between hazardous wastes and cancer; however, “Company Town” presents a formidable case. The air, earth and water of Crossett, with its population of about 5,500 people, have been spoiled by harmful fumes and vapors, by chemicals discharged into unlined basins, by fiber products and ash hidden in fields beneath a few inches of dirt and behind fences that do not solve the problem of carcinogens leaching into creeks and wells. Congregants in Pastor Bouie’s church speak as or about the children and adults dying in what amounts to a lethal cancer cluster.

Pastor Bouie organizes his neighbors with the help of a woman who serves as the Ouachita Riverkeeper and a whistle-blower who had been a safety coordinator in the mill. Together, they gain the attention of representatives of the Environmental Protection Agency and the Arkansas Department of Environmental Quality. At hearings, a number of these officials proffer placating but prevaricating reassurances.

Somehow a few days before the arrival of one set of bureaucrats, the smoke from the Georgia-Pacific facility decreases and the air smells better. After the meeting, the noxious plumes reappear.

Government spokespeople, the Koch brothers and the supervisors of Georgia-Pacific dispute the directors’ argument and evidence. Yet “Company Town” mounts a passionate protest on behalf of overlooked victims of corporate negligence and greed.

By putting into play the words “race” and “cancer,” the film motivated me to ponder the impact of race on cancer outcomes nationally — and therefore disentangled from local ecological factors. The big picture is grim.

A 2016 report of the American Cancer Society states that the “five-year relative survival is lower for blacks than whites for most cancers at each stage of diagnosis.” African-American men, for example, are twice as likely to die from prostate cancer. Experts continue to debate why, even as many ascribe this scandalous phenomenon to inequalities in access to screening and treatment.

In women’s cancer, the mortality gap has widened. According to the 2016-18 report on Cancer Facts and Figures for African-Americans, “despite lower incidence rates for breast and uterine cancers, black women have death rates for these cancers that are 42 percent and 92 percent higher, respectively, than white women.” Investigators connect the ghastly numbers to the usual socioeconomic discrepancies but also to biological differences in the malignancies of black women.

With regard to breast cancer, is the mortality gap related to a greater percentage of black women than white women contending with an aggressive form of the disease that lacks estrogen receptors?

Dr. Otis Webb Brawley, the chief medical officer of the American Cancer Society, rejects an explanation based on “biological difference,” pointing instead to dietary disparities.

Disadvantaged Americans consume more calories and carbohydrates, “the sort of food that is available in poor areas of inner cities,” Dr. Brawley writes in his book “How We Do Harm.” Greater body weight means African-American girls menstruate earlier and the number of uninterrupted menstrual cycles increases the risk of breast cancer: “The black-white gap in the onset of menstruation and body weight has dramatically widened, which means that the disease disparities will widen also.”

Dr. Brawley quotes an all-white study in Scotland that “found evidence pointing to a correlation between social deprivation and incidence of breast cancer that lacks estrogen receptors.” In addition, he cites the insight of his friend Dr. Samuel Broder, a former director of the National Cancer Institute: “Poverty is a carcinogen.”

Given the mortality discrepancies, it is disturbing that African-Americans are underrepresented as subjects in cancer research, as are other minorities. According to research by Dr. Narjust Duma of the Mayo Clinic, only 6 percent of participants in clinical trials are black, although African-Americans make up approximately 12 percent of the population; Hispanics amount to 3 percent of participants, although they make up about 15 percent of the population.

“If our government doesn’t fix this,” one protester in “Company Town” says, “then I don’t know what kind of government they are.” If we don’t fix this, I chime in, what sort of people are we?

via Black Cancer Matters – The New York Times

About Andrew
Andrew blogs and tweets public policy issues, particularly the relationship between the political and bureaucratic levels, citizenship and multiculturalism. His latest book, Policy Arrogance or Innocent Bias, recounts his experience as a senior public servant in this area.

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