From Mark Levine, the Doc with Pink Tights
Where You Live and Breast Cancer

My Editor has reminded me that it is time for another article. She asked that I consider writing the fourth part of `The New Norm.’ I enjoy writing medical stuff and have been doing so for the last 35 years (mostly scientific papers and book chapters). This, by and large, is scientific and is stimulated by the research that I am doing at the time. I have really enjoyed writing `The Doc in Pink Tights’ series for BRIGHT Run, which allows me the freedom to explore other areas. These articles are often a reaction to day-to-day issues or topics that arise and that stimulate me to pick up the pen (actually tap away at my lap-top). For example, the last article on breast cancer screening was provoked by an email from a BRIGHT supporter while `The New Norm, Part 1’ was based on conversations with survivors. In terms of writing on a topic, I need to be spurred by an inner passion. Hence, today, I am not quite ready to tackle `The New Norm Part 4.’

If you receive The Hamilton Spectator, you will notice a recent series called `Code Red: Ten Years Later.’ This is an update of the original Code Red series from 10 years ago, which analyzed the relationship between health outcomes (i.e. age at death, emergency room visits) versus factors such as wealth and where one lived in Hamilton. That series described considerable differences. It showed that people who lived in lower central Hamilton had worse health outcomes than other parts of the city, such as Dundas and Ancaster, where residents had the best outcomes. The Spectator has now published the results of a recent update of their analysis on health outcomes versus neighbourhoods and wealth. Unfortunately, there has not been much improvement over the last 10 years. In fact, for many outcomes it is worse.

For a long time, it has been recognized that social and economic factors influence health. This is also the case for breast cancer. There are a number of studies from the U.S. that have shown that African Americans and Hispanics with breast cancer from poor areas have higher mortality than Caucasians from areas that are more affluent. There is less scientific information for Canada. However, I have no doubt that the same relationship exists (i.e. people from poor neighbourhoods have worse outcomes). Why is this? These people tend to present with later stage, more advanced breast cancer. They lack support systems to help them while they are receiving treatments. As a result, it can be more difficult for them to get to their appointments at the clinic and it can be more difficult to give them treatments such as chemotherapy. Finally, patients who present with breast cancer and have a low socioeconomic status often have other major health conditions, such as heart disease and chronic lung disease.

Socioeconomic factors are a major determinant of health in our country. There are no easy answers to solving this problem. Attempts that have been made for breast health include: the use of the Mobile Cancer Screening Coach, and increasing the number of family physicians in these areas. It is very sobering to me that in cancer care we tend to focus on highly technical and expensive treatments yet we are struggling to grapple with the impact of social and economic factors on health. You would be interested to know that currently I am supervising a graduate student who is conducting research related to this issue.

I would be very interested in hearing your thoughts to this article.