Fighting Breast Cancer In D.C.'s African-American Neighborhoods

Just as the recognition of high breast cancer mortality rates in African-American women increases, funding for programs that specifically address them is being dramatically reduced.
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The recent media attention to psychosocial, cultural and economic issues contributing to high breast cancer mortality rates in African-American women strikes us as both well-deserved and ironic. Just as recognition of the power of these disparities increases, funding for programs that specifically address them is being dramatically reduced.

For the past five years, Smith Center for Healing and the Arts has run an innovative breast cancer awareness program to save lives and provide deep, impactful support and targeted education for thousands of low-income black women in the District. Like many cancer support programs, our Community Patient Navigation Program must now face major losses in private grant funding and either find new, private support or begin dismantling the program.

Adding to this devastating loss, Mayor Gray's 2013 budget proposes the elimination of the D.C. Healthcare Alliance, a safety net for residents who can't afford medical insurance, creating a perfect storm that will leave many women on their own in the fight against cancer.

This news comes just as Sinai Urban Health Institute in Chicago confirms what we already knew: black women are dying needlessly from breast cancer because they don't have information and access to proper care, in no small part because of a culture of fear and hopelessness. In other words, poverty, silence, and racial inequities -- not genetics -- are responsible for high death rates among black women.

Smith Center -- the only stand-alone cancer support organization in Washington, D.C. -- responded in 2007 to the District's daunting breast cancer statistics by launching the Navigation Program to address the specific challenges facing low-income African-American women. Through research conducted in collaboration with the Center for Urban Progress at Howard University, we concluded that fear and deeply entrenched psychosocial and cultural barriers to seeking care were often as isolating as the physical barriers such as poverty and geographical division.

These findings shaped all of our subsequent program efforts, and drove home the critical need to end the silence around cancer, to keep the topic visible in the community and to offer women concrete ways to become more invested in their health and well-being.

We shifted our hospital-based program into neighborhoods, partnering with churches and community organizations to reach people where they live. The navigators, all of whom are African-American breast cancer survivors, provide education, outreach and individual counseling focused on wellness, diet and nutrition, stress reduction and early detection. Smith Center's integrative navigation model also directly addresses fear, social issues and other non-medical aspects of cancer by including elements of psychosocial support and holistic lifestyle practices.

The Sinai Urban Health Institute study calls for a public commitment to ensure that quality breast health care, from screening to treatment, is available to all women, regardless of their ability to pay. But at the very moment we are reminded of the importance of our outreach efforts, organizations like Smith Center face insurmountable obstacles to continuing the vital work that directly addresses these problems in our own community. If we are going to overcome this astonishing disparity in the Washington area, we must prioritize funding to keep such programs in place and to help them flourish in our community. Without them, we will be leaving our most vulnerable sisters on their own to navigate uncharted and frightening waters. That is not what a compassionate community is supposed to do.

Shanti Norris is co-founder and executive director of Smith Center for Healing and the Arts.
Carole O'Toole is Smith Center's Director of Integrative Patient Navigation.

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