About 35,280 new cases of cancer are expected to be diagnosed in Indiana this year with breast cancer and lung cancer topping the list. An estimated 13,690 will die, according to the American Cancer Society.
A new population health study reveals that African-American Hoosiers have a lower incidence of many cancers, but they die at a higher rate, according to author and lead scientist Susan M. Rawl, professor of nursing at Indiana University School of Nursing and co-leader of cancer prevention and control at the IU Melvin and Bren Simon Cancer Center.
The study looks at differences in cancer-related knowledge, beliefs and behaviors between racial and socioeconomic groups in Indiana counties with the highest cancer death rates. The study conducted by the IU cancer center and the Regenstrief Institute was funded by the National Cancer Institute. Twelve other cancer centers in the U.S. are conducting similar studies. Ultimately, each cancer centers’ data will be merged to offer a national understanding of the results.
“We were funded by the NCI to do a study of the health of our population in Indiana to understand their cancer-related knowledge beliefs and behaviors,” said Rawl. “We asked about screenings, smoking — the things that reduce or increase your risk of getting cancer — to address the needs of our population in our state.”
“It provides us with a fundamental understanding of what does health knowledge and belief look like in the state of Indiana. Now that we know what it looks like we can go on,” said Joy L. Lee, health services researcher at the IU School of Medicine and Regenstrief Institute. Over time, the data will be mined for other findings.
According to Rawl and Lee, some of the initial results confirmed their hypothesis that higher income resulted in more cancer screenings, less smoking and more physical activities and regardless of race, respondents with low income and low education had poor access to health care.
“None of that really surprised us — that people who have greater resources have access to better care. Income was associated with scans for lung cancer, or screenings for colon cancer — not surprising,” said Rawl. “A couple of things surprising were that African-Americans tend to think they were not at risk for cancer or were less worried. It was very surprising finding that black women were more likely to have cervical screening in the last three years than white women.
“That flew in the face of other data. The women who disproportionately die are higher among our minorities — specifically African American or Hispanic women. The results popped off the page. Our black women were much more likely to be up to date (on screenings). We have to figure out how to explain that. Without analysis — the proportion of the surveyed people were in urban areas. The white population was more likely to live in rural areas. We don’t have data to explain it yet.”
“I’m absolutely seeing all these things,” said Roland Walker, pediatrician and owner of Walker Medical. Walker is also the executive director of the Northwest Indiana Health Dept. Cooperative, which is the lead agency for Lake County Tobacco Free.
Walker points to cervical cancer screening.
“I believe that has to do with how we are taught to screen in the African-American community — the recommendations are the same for all races — but it is emphasized more that cervical cancer is higher in the African-American population. So physicians look for it. The next question — after you screen — what do you do with it? How do you make sure they have access to care and faith in the care they are getting? I think it matters not just by race — but by gender and by age. As an example, women of all races of child-bearing age tend to see more primary care. Women of child-bearing age will see an (obstetrician) and get screened – any population that is having more [obstetrician] visits are going to have more screening. It matters how they break it down by men, by women, and by age.”
Walker said he has medical offices in Gary and LaPorte and has the opportunity see patients who live in urban as well as rural environments.
“The demographics are so different. The Gary office is 90 percent African-American. My LaPorte office 50 percent Caucasian and 25 percent Hispanic and 25 percent African-American. Most of my African-American patients in LaPorte reside in Michigan City. Both areas are a higher-risk cancer area. LaPorte has a lot of farming — Gary more industry. LaPorte (patients) might be more likely to have throat or tongue cancer from chewing tobacco. You don’t really see that in North Lake County. It’s just different.”
Rawl also offered a public message of thanks to the anonymous participants from Northwest Indiana.
“Thank you to the local counties, for the research would not be possible without them,” said Rawl.
“A lot of times, cancer sounds scary and this study is on the population level and might seem hard for the average reader to relate to,” said Lee. “But there are steps people can take. That is another important aspect and that is very concrete and not scary. They can have a conversation with their doctors. Patients and doctors have to have the same goals and understanding of what is healthy. If they are concerned, (people should) start with a conversation with their doctors.”