in brief 4

Closing the gap

The pattern is clear. Since the early 1980s, African-Americans have been dying of breast, prostate, and other cancers in greater numbers than Caucasians. In 1980, black and white women with breast cancer faced similar death rates. By 1990, a black woman’s risk of dying of breast cancer was 16% greater than a white woman’s. And by 1995, that percentage difference had grown to a staggering 29%.

Yet race is not a factor—at least in terms of genetics, says Otis Brawley, (left) recently recruited to Emory’s Winship Cancer Institute as associate director for cancer detection, control, and intervention and professor of hematology and oncology. “The genetics of black folks didn’t change in the past 25 years,” he says. “I believe a big part of the reason these disparities exist is in the quality of care received.”

Brawley cites studies conducted by large health care systems, the Department of Defense, and health maintenance organizations, showing that equal care yields equal treatment among equal patients. Race, he argues, may mask the real culprits—poverty, diet, tobacco and alcohol use, and inadequate health care.

Brawley, one of the nation’s foremost leaders in cancer prevention and a preeminent researcher of health disparities, will lead Emory’s physician effort at the Center of Excellence at Grady Memorial Hospital, recently inaugurated by the Georgia Cancer Coalition (GCC). The coalition is a public-private partnership that brings together Georgia’s leading hospitals and universities, biotech firms, civic groups, and nonprofit and government agencies. The center at Grady is the first of three to be established by the GCC in the state.

The GCC “may be the largest and most well thought out” use of tobacco settlement money in the country, says Brawley. “Unfortunately, a number of states are using the tobacco money to fill potholes and build highways. Here, in addition to improving health, there is a public-private aspect to the plan with a goal of luring more pharmaceutical and biotech companies that, in turn, will employ more people. The money is being leveraged in a way to get the biggest bang from the buck in terms of the number of people who will benefit.”

An internist and oncologist trained at the University of Chicago, Case Western, and the National Cancer Institute, Brawley was recruited from the NCI, where he was assistant director for special populations research. He was one of the architects of the Prostate Cancer Prevention Trial, which to date has enrolled more than 18,000 men in some 200 sites around the United States to study the epidemiology of prostate cancer and the efficacy of screening.

Brawley sees both great needs and resources in Atlanta. Health disparities are tremendous here, with breast cancer death rates among black women among the highest in the country. The opportunity to work with a primarily African-American population at Grady and to build a center of excellence to serve them was a challenge he welcomed.

The first step in creating a comprehensive screening, evaluation, and treatment center at Grady will focus on a state-of-the-art facility. Renovation of the ninth and tenth floors of Grady will provide treatment and operating rooms, clinics, and areas for education. The center should be fully operational by late 2002. (BACK TO TOP)