(Announcer Open):
We’re going to establish the program today with a guest from the National Cancer Institute – it’s Dr. Harold Freeman, quite a famous name in oncology circles. He’s an Associate Director of the National Cancer Institute – that’s the NCI – and Director of NCI’s Center to Reduce Cancer Health Disparities.

I welcome you, Dr. Harold Freeman.

(Freeman):
It’s good to be with you.

(Announcer):
You probably are one of the most respected physicians in your area and you have worked so hard – I remember you from the days when you were the Director of Surgery of Harlem Hospital in New York.

(Freeman):
That’s right.

(Announcer):
You are also Professor of Clinical Surgery –

(Freeman):
At Columbia University.

(Announcer):
Is there anything – I know that you’re the Medical Director of the Ralph Lauren Center for Cancer Care and Prevention.

(Freeman):
That’s also true.

(Announcer):
How do you have time to do anything else?

(Freeman):
Well, you just work as hard as you can every day.

(Announcer):
Well, thank you for taking time out – from a different time zone, and with all of your other responsibilities – to join us. And because it is National Minority Cancer Awareness Week, I think it’s important – though we’re really going to be focusing today on breast cancer – to really establish an understanding of why do we need this week, and in addition to breast cancer, there are particular cancer risks that impact African-Americans and other minority patient populations and I’d like you to sort of give us an overview, please.

(Freeman):
Yes. First of all, black Americans in general have the highest incidence of cancer overall, particularly black males, and the highest death rate from cancer. So that in itself is a reason that we should focus. The reasons for the higher death rate we have been studied and we’re still trying to refine the answers, but clearly it’s partially related to economic status. There’s a higher poverty rate among black Americans. In particular, 25% of black Americans are poor by the standard of poverty compared to 8% of white Americans and that has an effect. Also, the behavior factor is key. For example, the number one cause of cancer deaths in America among all races, and in black Americans in particular, is lung cancer. And 90% of lung cancer is due to cigarette smoking, but black males have the highest rate of smoking in America, therefore they die more of that particular disease.

Another factor that we have to bring into this is the inequality issue. Both historically and currently, groups of people who have not been treated fairly historically tend to be poorer and have less education and to the extent that there’s any inequity in health care going on at this point it also is a factor.

So in general, let me state that 132,000 black people will develop cancer of all types this year and 63,000 will die. And the incidence rate and death rate are both higher in black Americans than in any other group.

(Announcer):
Dr. Freeman, what about the issue of trust – trusting the system, the provider – and access to care in general?

(Freeman):
The issue of trust is very important. Because we have studied the issue to some extent, we find that black Americans in general do not tend to trust the health care system and its providers as well as others do. This is not an irreversible situation and I believe that the more sensitive people we get into the health care system as doctors and nurses and others who are sensitive – perhaps belonging to the ethnic group, but not necessarily so – the better we can improve that condition of lack of trust. For example, in Harlem where I worked for almost 40 years as a surgeon, I don’t find the issue of trust to be very important. I believe the people, if they’re approached in a certain way, with sensitivity and care and concern, that these people will trust their caregivers.

(Announcer):
Interesting to report that last week we did a program with the Society of Gynecological Oncologists and at this year’s meeting it was reported that African-American women with endometrial cancer have more aggressive cancer than white women. And we discussed it at some length last week, but how can we explain not only the disparities, but perhaps the different biology by race when it comes to different ethnic groups and how cancer presents and why it would be more aggressive, perhaps, in one ethnic group than another.

(Freeman):
That’s a very important question and it’s being debated among scientists right now.

My own view is this: Since the determination of racial categories is not based on biology in the first place, but it’s based on social and political classification, it’s hard for me to believe that being black in and of itself will drive biological disparities. However, mutations can be affected by environment. And so people are exposed to toxicity and unhealthy environments and cigarette smoking and other carcinogens it is possible that mutations can occur and more aggressive tumors can occur based on more environmental concerns rather than innate race in itself.

(Announcer):
Please take a moment to talk to us in urging the awareness on behalf of black men and prostate cancer, and maybe some comments on colorectal cancer as well.

(Freeman):
Yes. Well, prostate cancer is a very, very special disease. First of all, black men in America have the highest incidence of prostate cancer compared to any other group of men in the world – this is very important – and also have a higher death rate when they are diagnosed with prostate cancer. So we don’t know the reasons for this, but the things that we’re focusing on in our scientific investigation are diet, in particular, and hormonal makeup. It appears that men who have a higher meat and fat diet have a greater tendency worldwide to develop prostate cancer. The other point that I’d like to make is that if black and white men are treated at the same stage of prostate cancer, with the same treatment, they have the same results. And this is an important point to understand, that equal treatment at the same stage of the disease seems to trump race.

(Announcer):
Colorectal cancer.

(Freeman):
Colorectal cancer. First of all, this is probably the second most important cancer in America after lung cancer. It is the number two cause of cancer deaths because it operates in both sexes, whereas breast cancer of course is a female disease and prostate cancer is a male disease. But here the great challenge is that we now know that we could prevent up to 80% of colorectal cancers from ever occurring if everyone had the screening test beginning at about age 50. So we can pick up this disease before it becomes cancer because it first appears in the form of small polyps that can be removed during colonoscopy. And we believe that those cancers that have already been formed at the point of colonoscopy could be diagnosed and treated earlier. So here we have a disease that kills 55,000 American people every year, disproportionately among black people, but we have a way to almost eliminate this disease if everyone would undergo the test called colonoscopy beginning at age 50. And if you’re clear on that test, you can have it ten years later, which is not so bad.

(Announcer):
Yes, although we’ve talked about maybe not waiting a complete ten years to repeat it, but I understand that polyps are slow growing so you can stretch that time a little bit.

(Freeman):
Yes.

(Announcer):
In a moment we’re going to have to take a break, but quick comment: summer’s here and I think that it’s not completely unusual to see even people of darker skin to have melanoma. I know that we have had calls from black patients who have presented with melanoma between their toes, on their feet. I just want to clarify as many myths as possible, so perhaps you can just address, now that summer’s here, melanoma.

(Freeman):
Whereas it is know that darker-skinned people have a lower incidence of melanoma, yet melanomas do occur in black people. First of all, there are some black people who are not dark skinned and they have to be just as careful as people who are called white. It is the lightness of the skin rather than what race you’re called. But when black people develop melanoma, they frequently develop it in areas that are somewhat unusual, like the sole of the feet or mucosal surfaces that are not typical.

So blacks should be aware of this disease, melanoma, and other skin cancers, but clearly the higher the pigment in the skin naturally, the more protection a person has against melanoma.

(Announcer):
Thank you, Dr. Freeman.