MEMPHIS, Tenn. — After her doctor told her two months ago that she had breast cancer, Debrah Reid, a 58-year-old dance teacher, drove straight to a local funeral home. She began planning a burial with the funeral director and his wife.

Sensing something was amiss, the funeral director, Edmund Ford, paused. “Who is this for?” he asked.

Reid replied quietly, “It’s for me.”

Aghast, Ford’s wife quickly put a stop to the purchase. “Get on out of here,” she said, urging Reid to return to her doctor and seek treatment.

Despondent, Reid instead headed to her church to talk to her pastor. “I was just going to sit down and die,” she says.

Like many black women in Memphis and around the country, Reid learned about her breast cancer after it had reached an advanced stage, making it difficult to treat and reducing her odds of survival.

Her story reflects one of the most troubling disparities in American health care. Despite 20 years of awareness campaigns and treatment advances that have improved survival rates, the majority of those gains have bypassed black women. Although breast cancer is diagnosed in more white women, black women are more likely to die of the disease.

Memphis is worst

Memphis is the deadliest major U.S. city for black women with breast cancer. They are more than twice as likely to die from it as white women here.

“The big change in the 1990s was advances in care that were widely available in early detection and treatment,” said Steven Whitman, director of the Sinai Urban Health Institute in Chicago. “White women gained access to those advances, and black women didn’t.”

Researchers from the Sinai Institute last year analyzed breast cancer cases in the country’s 25 largest cities and found that black women with breast cancer were, on average, 40 percent more likely to die of the disease than white women. In the U.S., the disparity in breast cancer survival translates to about 1,700 additional deaths each year — or about five more every day.

When the breast cancer disparity study was published in the journal Cancer Epidemiology last year, Edward Rafalski was one of the first in Memphis to read it. He is senior vice president for strategic planning at Methodist Le Bonheur Healthcare, which operates eight hospitals in the Memphis area.

As it happened, Rafalski knew the study’s lead author, Whitman. As local headlines declared the city’s troubling record, Rafalski invited Whitman to the city.

Roots of disparity

The solution, everyone agreed, would not be simple. Doctors and health care researchers say the reasons for the black-white cancer divide are complex.

Economic disparities that disproportionately affect blacks explain some of it. Years of racial discrimination and distrust of the medical establishment continue to influence health decisions made by black families in the South.

Lack of health insurance among low-income and self-employed women was also cited as an obstacle to timely care.

In 2005, the Methodist hospital system formed the Congregational Health Network. It began with 12 Memphis-area churches and has grown to more than 500 congregations.

Through the network, the hospitals have registered 18,000 people and promoted prevention, screening and health education among them. An analysis of hospital records shows that patients in the network fare better, staying out of the hospital four months longer than non-network patients with similar diagnoses.

Rafalski and his Methodist colleagues realized that this network would be the best way to reach out to black women on breast cancer issues. With a grant from the Dallas-based Susan G. Komen Foundation, they hired Carole Dickens to work with pastors and congregants.

During Sunday services, she spreads the word about early screening, gives women her cellphone number and follows up with those who share their contact information. She helps them gain access to public health programs and offers taxi vouchers so they can get to medical appointments.

Many of the women admit never getting a mammogram and avoiding doctors. Sometimes, it is because they do not have health insurance. Others are stopped by fear. “They have all kinds of reasons for not doing it,” Dickens said.

After the funeral home refused her business, Reid sought counseling from the Rev. Robert J. Matthews of the New Hope Baptist Church of Memphis. He is a 12-year survivor of colon cancer, and their talk was transformative for her.

“I’m not a weak person,” she said. “I decided to be a messenger.”

While Reid, who has Stage 3 cancer, hopes her story will help other women, she knows that education is not enough. “A lot of us don’t have insurance,” she said. “And without insurance, a lot of stuff goes undetected.”

Tara Parker-Pope,

The New York Times