Bonnie Arbittier / Rivard Report
Of the estimated 925 Bexar County women who will be diagnosed with breast cancer in 2018, as many as 180 will die from the disease, according to a community analysis by the local affiliate of the Susan G. Komen organization.
The same analysis showed that the risk of being diagnosed with breast cancer is significantly higher for women living in zip codes where high levels of poverty are coupled with large minority populations and low educational attainment.
By using community-level census data and information from the Texas Cancer Registry on local diagnoses, Komen San Antonio identified 32 Bexar County zip codes in which women are at higher risk for late-stage diagnosis and for not surviving the disease, said Elyse Bernal, executive director of Komen San Antonio.
The organization, which funds breast cancer research and breast cancer screening and treatment, is using that information to target local communities where women are most at risk, with the hopes of educating women about the disease, encouraging them to get breast exams or mammograms, and connecting them to services when needed.
“If we are going to make a dent in the breast cancer issue in Bexar County, we have to prioritize and be strategic with the populations we are serving,” Bernal said, noting that minorities are disproportionately affected by breast cancer.
Black women are at greater risk of dying from the disease, and Hispanic women are more likely to be found with large cancerous tumors and be diagnosed later in the disease's progression, she said.
"We know that these are two groups that are disproportionally affected by breast cancer," Bernal said.
Once the 32 zip codes were identified, the analysis went further, looking into whether zip codes were within medically underserved areas, had high levels of unemployment, low levels of education, and high uninsured rates.
"All of those things together [create] a perfect storm for finding breast cancer late and finding it when it's least treatable," Bernal said.
Of the 27 zip codes Komen San Antonio targeted for Hispanic women, the majority are within Loop 410, downtown San Antonio, and the Southside. One cluster of zip codes, 78201 through 78212, and 78215, constituted the highest number of breast cancer diagnoses from 2011-15, with 894 diagnoses.
The 12 zip codes in the Komen analysis found a high rate of breast cancer diagnosis among black women are mainly concentrated on the Northeast and East sides of Bexar County, including 78244, 78239, 78202, and 78219.
To reach these communities' at-risk women, Komen partnered with the Martinez Street Women’s Center to implement a promotora program using community health workers to provide information about preventive care and help women get that care. Promotoras reach out to women in high-risk zip codes by going door-to-door throughout neighborhoods, partnering with community centers, and distributing information at grocery stores to inform women about where they can receive services and the importance of regular clinical breast exams.
"Real health care is making sure that everybody has access to the things that will make them healthy," said Dr. Junda Woo, medical director at the San Antonio Metropolitan Health District. For women at high risk for breast cancer, that includes access to clinical breast exams, healthy food, and safe spaces to exercise, factors that may not be available in impoverished areas, she said.
The disease affects one in eight women in the United States, and is the leading cause of cancer death among women, according to Susan G. Komen. While rates of female breast cancer dropped 39 percent from 1989 to 2015 – and have continued to decrease in older women – breast cancer rates have remained steady in women younger than 50, Komen reported. White and black women have the highest incidence of breast cancer overall.
At age 31, Jillian Denys was diagnosed with Stage 4 breast cancer in 2016. She had given birth to her first child, a healthy baby girl named Kate, just three months earlier. Although Denys doesn't live in a high-risk zip code, her case illustrates the difficult battle facing women with Stage 4 cancer.
A debilitating side pain lasting several days prompted her to go to the emergency room; at the time, she thought she had appendicitis. Diagnostic scans found her liver covered in tumors, which led to a breast cancer diagnosis.
Denys told the Rivard Report that after receiving her diagnosis, her first thoughts were about whether her daughter was going to have to grow up without her mother.
“I [thought], 'Oh my God, I’m going to die' – the life expectancy [for my diagnosis] is that 20 percent of people survive after five years,” said Denys, who regularly underwent women's wellness exams before her diagnosis.
For women diagnosed with Stage 4 breast cancer, treatment may include systemic treatment such as chemotherapy and hormone therapy, and local treatment like surgery or radiation to help prevent or treat symptoms.
In the last two years, Denys has undergone rounds of chemotherapy, radiation, and medication that caused her to lose her hair on two separate occasions. But the cancer now has spread to her brain, a diagnosis she received one day before her daughter’s first birthday.
“When you have Stage 4 cancer, you keep getting [chemotherapy] until it stops working,” Denys said, noting that she is currently undergoing chemotherapy and taking medication for her brain tumors. “I know it’s not great when it spreads to your head, but [doctors] are now trying to look at breast cancer” as a chronic or recurring illness to be consistently treated over time.
Bernal said that cost is often a deterrent for women in need of clinical breast exams, which is why the promotoras program is integral to educating women in high-risk zip codes about what their options are. She explained that in addition to footing the bill for women’s wellness exams, Komen also has funding to “make sure there is a continuity of care.”
In a partnership with UT Health San Antonio, the center hosts pop-up clinics to provide free clinical breast exams to women who need them, and to connect them to a medical home where they can continue to receive treatment when necessary.
“We are working to make sure that we are attacking the disease as a whole in San Antonio and not leaving any gaps for any women when it comes to a continuation of care,” Bernal said. The Martinez Street Women’s Center helps Komen San Antonio get access to women in defined high-priority areas, and communicate what services are available.
"We can't just leave these people here" after they are diagnosed, Bernal said. "We want to communicate that we help them after they finish their screening, when and if they need treatment, and to help with the things they may need" throughout treatment and after, such as specialized clothing and bras.
Denys said that when she was diagnosed with Stage 4 cancer, the first question she asked her doctor was: "How much longer do I have?" Fast forward to today, she says she feels hopeful.
"There have been so many breakthroughs already, in the past 10 years even," Denys said, noting the chemotherapy treatment she receives was created in 2007, and many drug trials since then have had positive outcomes. "I hope [a cure] happens during my lifetime, but I think they are getting very close."