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Guest Columnist

Marc Hurlbert, PHD,
Executive Director, Avon Foundation Breast Cancer Crusade

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Delivering Medical Discoveries to Benefit All Who Face Breast Cancer – Regardless of their Income Level or Insurance Status

The field of breast cancer has witnessed remarkable progress due to dedicated scientists, physicians and advocates. Sixty years ago, a woman diagnosed with early stage breast cancer had a 55% chance of living 10 years, while today those odds are >85 percent. We've made great advances in finding cancer early with imaging including digital mammography, ultrasound and, when appropriate, MRI. Less invasive surgery is the standard of care in most cases, with lumpectomy and radiation instead of mastectomy. Research has determined breast cancer is not a single disease, but rather 5 or so distinct types, each with different approaches to target and optimize treatment. For women diagnosed with advanced breast cancer that has spread to other parts of the body, we still have much work to do, but even their 10-year survival odds have increased substantially.

These advances are remarkable. However, they do not benefit all women equally. There is a disparity in access to screening and treatment that leads to a disparity in survival. Mortality rates from breast cancer for white women and black women were essentially equal in 1975 and remained equal until the late 1980s. By 2005, the black:white rate ratio of breast cancer mortality was 1.36 for New York City, 1.38 for the US, and 1.98 for Chicago. The disparity in breast cancer mortality that has arisen in the last 15-20 years is primarily due to unequal access to quality early detection and timely and quality treatment.

The Avon Foundation Breast Cancer Crusade has awarded more than $700 million in grants to support programs to combat disparities in breast cancer. As one example, in 2000, we launched the Avon Breast Health Outreach Program to support grass-roots community education throughout the country. Avon BHOP programs educate women in the hardest to reach communities including education and support targeted to reach ethnic and minority communities, women from lower socioeconomic levels, the uninsured and women from inner city to rural regions. The Avon BHOP has educated more than 10-million women and linked more than 1-million women to mammography screening and early detection programs. Two-thirds of the women served were uninsured, 60% live below the federal poverty level, and 59% were from racial or ethnic minority groups. The Avon BHOP programs have successfully implemented evidence-based strategies to promote screening among the medically underserved. Highlights of a few Avon BHOP programs are in this video.

Linking women to screening and finding cancers when they are small and more treatable is only one approach the Foundation takes. In addition, we support a network of 100 Avon Safety Net Hospitals and 'Avon Patient Navigators' which take this a step further by supporting women from the screening process all the way through to biopsy and diagnostics, and navigating the medical and financial maze to help provide access to quality treatment. The field of navigation and the evidence-base for this type of intervention is still developing. However, in early data analysis, several of the county and public hospitals that Avon Foundation supports report sharp decreases in late-stage diagnoses, increases in early stage-diagnoses and improvement in 5-year survival odds.

Much progress had been made to-date, but we look forward to the future. 2012 marks the 20th anniversary of the Avon Foundation Breast Cancer Crusade as well as the Avon Walk for Breast Cancer's 10th Birthday celebration. Avon Foundation will continue the Crusade until we defeat breast cancer.

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