Today, Cancer Research UK and Public Health England announced that a recent analysis of cancer data revealed that black women are twice as likely to be diagnosed with late stage breast cancer as their white counterparts. They found that 25% of black African breast cancer patients and 22% of black Caribbean patients had late stage disease compared to 13% of white patients.

The fact that black women are more likely to be diagnosed at a late stage has been known for some time and has also been observed in not just the UK but in the USA too. The Lake Foundation has conducted work in this area to explore the possible reasons behind this. In 2011, we carried out some qualitative research to explore black women’s beliefs about breast cancer and their help-seeking behaviour to determine whether these two factors may lead to delays in diagnosis. Overall our study suggested that, when it comes to seeking help, black women are quite proactive and there would be no delay in visiting their GP (doctor) if they noticed a breast lump; delays in visiting a GP could occur if black women experience other symptoms as they were less aware of these.

We also found that the following factors could delay help seeking in black women: other priorities such as family or work commitments; language barriers; lack of access to information; age (older people are more likely to delay visiting their GP); difficulty getting appointments; cultural insensitivy of the healthcare system, inaction by GPs; and a lengthy referral process. You can read more about this work on our research page (scroll to the bottom of the page).

National data suggests that black women are less likely to take part in the NHS Breast Screening Programme and this could be another reason for the late stage diagnosis. In 2011, our founder Abi Begho worked with Betterdays Cancer Care, the NHS and Cancer Black Care to determine why black women are less likely to attend breast screening and whether patient navigation could be an effective way of improving screening uptake in black women in Peckham and Lewisham. We found that, at the time, black women living in Lewisham and Peckham who were of screening (over the age of 50) were very mobile with many women being unreachable, on an extended trip abroad; having moved from their GP registered address or had relocated and lived abroad,  hence they missed their breast screening appointments. We found that patient navigation was effective at reaching women as numerous and extensive attempts were made to contact women and then support them to attend their screening appointments. You can read more about this work here

Finally, scientific research has also suggested that black women are more likely to develop a more aggressive form of breast cancer which grows rapidly, so this could explain some of the late stage cases. Studies also suggest that black women are more likely to develop breast cancer at a younger age.

This recent analysis by Cancer Research UK has reminded the nation that there is an issue around black women and breast cancer that needs to be addressed. We need to ensure that black women are aware of all the signs and symptoms of breast cancer and that they seek help quickly if they notice any of the symptoms. We also need to understand the biology of the disease and the best ways of detecting and treating the more aggressive forms of breast cancer.

So, the message to black women is:

• Be aware of all the signs and symptoms of breast cancer
• If you’re worried about any symptoms that you have, please visit your doctor as soon as possible
• Eat a healthy diet, keep active and maintain a healthy weight to reduce your risk of developing breast cancer
• If you’re aged 50 or over, consider accepting your invitation from the NHS to take part in breast screening
• Know your family history. If you have a strong family history of breast cancer you may be at an increased risk so visit your GP for some advice and information

On 8^th November 2016 Target Ovarian Cancer will be holding an event called Being Together in Hertfordshire. This is a free event for all women with ovarian cancer and will take place at the Jurys Inn Hotel in Watford from 10am – 4:30pm and will include lunch and refreshments.

Feedback  from previous Being Together events have shown that these days are extremely beneficial in helping women feel less isolated and more knowledgeable about ovarian cancer:

“The whole day has been brilliant. The hospitality was superb and the quality of the event was excellent”

 The event is an ideal opportunity for women to meet those with similar experiences and put their questions to a panel of experts. Women will also have the opportunity to take part in workshops surrounding living well, such as nutrition and relaxation. Although the event is free booking is essential.

You can book a place at www.targetovariancancer.org.uk/hertfordshire or by calling Target Ovarian Cancer on 020 7923 5475.

 

 

We love social media. It really does open up the world to us and provides access to a vast amount of information that we would have struggled to find a decade ago.

Yesterday, we found ourselves mentioned in a Tweet. We thought: ‘interesting, thanks for the mention’ and then we proceeded to click on the link to explore further. We were taken to a summary of a British Heart Foundation funded research project about the African-Caribbean community and heart failure.

We just love this about social media. Information is so accessible; it literally falls into your lap (or Twitter feed!). It’s great when people take the time to seek you out and bring relevant information to your attention.

What exactly was being brought to our attention?

The research that was being brought to our attention by our fellow Twitter user was a study published in the journal of Circulation Heart Failure conducted by lead researcher Dr Jason Dungu from St Georges University of London. His work explored the causes of heart failure in different ethnic groups with a particular focus on the Afro-Caribbean population.  This research revealed that the cause of heart failure is dependent on ethnicity.

What did the researchers do in this study?

They looked at all patients with heart failure who attended St George’s Hospital Heart Failure Clinic between 2005 and 2012. These included 1392 patients, 211 of these patients were Afro-Caribbean.

Participants’ diagnosis of heart failure was confirmed through a medical history, an examination and various tests. The cause of their heart failure was determined by an initial assessment and then confirmed by a review of the patient’s records and through any investigations and findings.

What did they find?

The researchers found that the causes of heart failure varied based on ethnic group. For example the most common cause of heart failure in white patients was coronary heart disease; this was the cause of heart failure in 41% of white patients.  When they looked at Afro-Caribbean patients coronary heart disease was the cause of heart failure in just 13% of these patients.

In Afro-Caribbean patients the most common cause of heart failure was non-ischaemic dilated cardiomyopathy. This was the cause in 28% of Afro-Caribbean patients compared to 20% of white patients.  Other causes of heart failure in Afro-Caribbean patients included:

• hypertensive cardiomyopathy (12% of black patients; in white patients this was the cause in 2.2% of cases);
• cardiac amyloidosis (11% of black patients; in white patients this was the cause in 1.6% of cases)
• valvular heart disease (7% of black patients)

The finding that 11% of Afro-Caribbean patients developed heart failure due to cardiac amyloidosis was very significant. This is because whilst, generally speaking, cardiac amyloidosis is considered a rare condition, it features in 11% of Afro-Caribbean heart failure patients, making it the fourth most common cause of heart failure in this ethnic group. Additionally it was found that patients who develop heart failure due to cardiac amyloidosis had a lower survival rate than those who develop heart failure due to coronary heart disease. This means that more attention needs to be paid to these patients.

The Importance of this Research

This research reveals that when diagnosing and treating heart failure ethnicity needs to be taken into account and Afro-Caribbean patients have to be handled differently.

Thank you social media!

It’s great that through social media we can easily gain access to the latest research and we thank those that continue seek us out when relevant research is published.

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References

Afro-Caribbean Heart Failure in the United Kingdom: Cause, Outcomes, and ATTR V122I Cardiac Amyloidosis. Circulation: Heart Failure 2016; 9: e003352

This week researchers from the University of Otago in New Zealand published the results from their study which showed that taking a short walk after a meal may be effective in controlling the blood glucose levels of type 2 diabetics.

The researchers conducted this study to expand on the current advice that regular physical activity is effective in diabetes management. They wanted to determine whether the timing of  physical activity in relation to meals enhances the benefit of physical activity.

How did the researchers explore this?

To explore this, researchers conducted a study with 41 adults with type 2 diabetes. Participants either took part in 30 minutes of physical activity every day or were advised to walk for 10 minutes after their main meal. Both of these scenarios met the t physical activity guidelines for people with type 2 diabetes.   The blood glucose level of participants was then  measured 3 hours after each main meal.

What did they find?

The researchers found that  blood glucose levels were 12% lower when participants had walked after their meals compared to if they had just carried out physical activity once a day.  They also determined that the improvement was enhanced after the evening meal (22%), as this is the meal where the most carbohydrate is eaten and when people are more inactive.

What were their conclusions?

The study concluded that

“The benefits relating to physical activity following meals suggests that current guidelines should be amended to specify post-meal activity, particularly when meals contain  a substantial amount of carbohydrate.”

The importance of this research

The black community is three times more likely to develop type 2 diabetes than their white counterparts and the African and Caribbean diet tends to be quite rich in carbohydrate so this research is helpful for black type 2 diabetics in understanding how they can manage their condition.

As well as following your doctor’s advice on the type of diet you should be consuming, as a type 2 diabetic, make sure you are engaging in enough physical activity and from the results of this research, taking a short walk after your main meal appears to be of benefit.

Reference

Reynolds, A.N., Mann, J.I., Williams, S. et al. Diabetologia (2016). doi:10.1007/s00125-016-4085-2

September is Sickle Cell Awareness Month in the US and this gives us the perfect opportunity to focus a bit of attention on this condition which is more common in the black community. In this week’s blog we provide a quick introduction.

What is Sickle Cell?

Sickle cell anaemia is an inherited condition where the red blood cells which carry oxygen around our body develop into an abnormal shape. Instead of being round they form into a sickle shape i.e. a semi-circle. These abnormally shaped blood cells are sticky and stiff and they can block blood flow into your tissues and organs. The reduction in blood flow to your organs can cause pain, organ damage  and increase a person’s chance of developing infections.

What Causes Sickle Cell?

It is caused by  faulty gene which will have been inherited from the patient’s parent. The person would have inherited one copy of the gene from their father and another copy of the gene from their mother. If you only inherit one of the faulty genes you will not develop full-blown sickle cell, you will  be a carrier of the gene, but you can pass this gene down to your children.

If you are a carrier of the sickle cell gene you have enough normal blood cells to ensure that your blood flows adequately throughout your body but as a carrier you do have to be careful in situations where oxygen levels are low like when mountain climbing and scuba diving.

Complications of Sickle Cell

People with sickle cell may experience a number of symptoms and complications; everyone is different so each individual will have a different experience with sickle cell.  You may experience any of the following:

Episodes of pain (Sickle cell crisis)
This is the most common complication of sickle cell and occurs when sickle shaped blood cells block the blood vessels that supply a particular tissue. This means oxygen is unable to get to that tissue and it becomes starved of its energy source. This causes tissues to become damaged – this causes the pain. Repeated episodes eventually lead to organ damage. The episodes can affect your ribs,  spine, pelvis, abdomen, chest, legs and arms.

Anaemia
Anaemia is a decrease in the number of red blood cells in the body. Sickle cells do not live for a long time and when they die they are not replaced quickly enough so sickle cell sufferers will have a low red blood cell count which can lead to:
· Shortness of breath
· Feeling tired all the time
· An irregular heart beat

Infections
Children with sickle cell are prone to developing infections such as pneumonia, bone infections and meningitis. If your child has sickle cell they may need to have some additional vaccinations or be given antibiotics as a precaution.

Jaundice and Gallstones
The rapid break down of the sickled cells can lead to the build up of a  yellow waste product called bilirubin. This causes the yellowing of the skin and the whites of the eye, this is called jaundice.  The bilirubin can also solidify forming gallstones.

Stroke and Acute Chest Syndrome
If sickle cells block the blood flow to the brain this can lead to a stroke, and if it blocks the blood flow to the lungs this can result in acute chest syndrome where patients experience chest pain and difficulty breathing.

Treating Sickle Cell

Sickle cell cannot be cured and a treatment plan is developed to help sickle cell sufferers manage their disease. The aim of any treatment is to:
·  Prevent episodes of pain
·  Relieve pain
·  Minimise any complications
· Treat any other symptoms

Diagnosing Sickle Cell

Sickle cell is diagnosed through a blood test.  When a person has sickle cell this will become apparent when they are a child.  If you are worried that your child has sickle cell you can arrange for them to have the blood test by making an appointment to see your GP.  For couples who are expecting a baby and may be concerned that their baby may inherit sickle cell, your unborn baby can be tested from eleven weeks into your pregnancy. You can speak to your GP or obstetrician about this.

More Information

For more information on sickle cell please visit the Sickle Cell Society’s website

As the number of cases of Ebola continues to increase we hear about the heroic efforts of western doctors and nurses who have travelled to West Africa to offer their services, but we rarely hear of the sacrifices that countries outside of the west are making. In this week’s blog we highlight the response of the small Caribbean nation, Cuba, who has made a significant difference to the Ebola outbreak.

Cuba is the largest island in the Caribbean with a population of 11 million people and a GDP of $6,051.22 per capita (compared to the UK’s GDP of $39,336.91 per capita). This small nation with limited resources has been leading the effort to tackle the Ebola outbreak, sending more doctors and nurses to West Africa than any other country.

In September, Cuba sent 62 doctors and 103 nurses to Sierra Leone and since then has pledged to send 300 more medical personnel. To date, 256 Cuban doctors and health workers have been sent to Sierra Leone, Liberia and Guinea where they have been treating patients, setting up testing laboratories, helping to develop strategies to stop the transmission of the disease and accurately determining the number of Ebola cases in these three countries.

In addition to sending medical personnel to Africa, Cuba has been training healthcare workers throughout Latin America and the Caribbean on how to deal with Ebola and is currently hosting an Ebola conference in Havana with support from the Pan American Health Organisation and the US.

A response like this is not new to Cuba they have been sending medical personnel to deal with disease outbreaks for years. In 2010 Cuban doctors and nurses helped with the Haiti Cholera outbreak and Cuba has worked in Haiti since 1998. Cuba has also provided medical assistance to war-torn Algeria, hurricane-hit countries in Latin America and the US (hurricane Katrina), and following earthquakes in Chile and Haiti. Today, there are 50,000 Cuban healthcare workers providing assistance to 66 countries.

Cuba’s response to the Ebola outbreak has been so significant that it has won praise from the UN and World Health Organisation.

“Cuba is world-famous for its ability to train outstanding doctors and nurses and for its generosity in helping fellow countries on the route to progress.”

“I am extremely grateful for the generosity of the Cuban government and these health professionals for doing their part to help us contain the worst Ebola outbreak ever known.” – Dr Chan , WHO

Based on Cuba’s size and resources, its response to the Ebola outbreak has been heroic and we applaud them for this and are extremely grateful for their efforts.

What is Lupus?

Lupus is a chronic (it lasts a long time) disease where the body’s immune system doesn’t function properly and begins to attack healthy cells, tissues and organs.

There are four types of lupus. The most common type of lupus is systemic lupus erythematosus (SLE); it can affect many parts of the body such as the heart, kidney, brain and lungs. The second type of lupus is called discoid lupus erythematosus (DLE) and this affects the skin causing rashes and a change in the colour of the skin. Drug- induced lupus is caused by certain types of medication (for example hydralazine and procainamide which are used to treat heart conditions). It tends to be a mild form of lupus and goes away when the medication is stopped. Finally, neonatal lupus is a very rare type of lupus that affects new born babies.

It is not contagious, the severity of the disease varies from person to person – it can be mild or severe – and today, patients rarely die from lupus as an improved understanding of the disease and advances in healthcare has meant that patients can successfully manage their condition.

What Causes Lupus?

The exact cause is unknown but it is thought to occur due to a combination of genetic and environmental factors. There are certain triggers that cause someone’s immune system to become activated inappropriately and attack the body. These triggers include infections, drugs, sunlight and hormonal changes. These triggers as well as a genetic predisposition are thought to lead to lupus.

Researchers have found that there are a number of different genes that together dictate whether a person will develop lupus, what type of lupus they will develop and how severe it is.

What are the Symptoms?

Because lupus can affect a number of different organs and tissues, it can cause a variety of symptoms. The most common symptoms are:

• Joint pain
• Swelling of the joints
• Muscle pain
• Fever
• Rashes, mostly on the face
• Chest pain
• Hair loss
• Pale or purple fingers or toes
• Sensitivity to the sun
• Swelling in legs or around eyes
• Mouth ulcers
• Swollen glands
• Fatigue

Less common symptoms include: anaemia, headaches, dizzy spells, depression, confusion and seizures.

The symptoms and the severity of symptoms vary between people. Some sufferers will have episodes where they experience symptoms followed by periods where they have no symptoms whilst others will have symptoms all the time.

Diagnosis and Treatment

Diagnosing lupus is very challenging because recognising the symptoms can be difficult. This is because the symptoms can seem quite vague, are similar to those of a number of other conditions and they may come and go; this makes it hard to pin down what may be causing the symptoms. Furthermore,there is no specific test for lupus and this all means that it can take years for a patient to receive a confirmed diagnosis.

To make a diagnosis doctors have to carry out several tests and they’ll also have to look at the person’s medical history. The American College of Rheumatology has developed the ‘Eleven Criteria of Lupus’ to help doctors diagnose lupus. A person must have four or more of these criteria for a diagnosis of lupus to be made.

Lupus is incurable so when it comes to its treatment patients are typically given medication to help manage their symptoms and are also given advice on lifestyle changes such as avoiding triggers.

Who is at Risk of Developing Lupus?

Lupus is a fairly rare disease and in the UK it affects just 5 in 10,000 people. It is more common in women with 90% of suffers being women and most of these women are aged between 15 and 44.

Black women and Hispanic women are at a higher risk of developing lupus as are people who have family members with lupus, have taken certain medications and have been affected by specific infections such as Epstein-Barr virus and cytomegalovirus (CMV).

This means that the key risk factors for lupus are:
1. Age
2. Gender
3. Ethnicity
4. Family history
5. Taking certain medications
6. Certain infections

Lupus and Black Women

Black women are three to four times more likely to develop lupus than their white counterparts and results from the Lupus in Minorities study has shown that black women develop this condition at a younger age, experience more severe symptoms and overall develop more complications. When looking closely at these complications, black women with lupus tend to develop more neurological complications (such as seizures and strokes) and are more likely to develop lupus-related kidney disease.

Researchers are trying to understand why it is more common in black women and why it is more severe. It is thought to be due to a combination of genetic and environmental differences.

The Black Women’s Health Study identified four specific genetic differences that are associated with a higher risk  and these were seen in black women with lupus.

As work continues in this area we can begin to gain a better understanding of why lupus is more common in black women and hopefully this will provide information that can help in the development of effective treatments.

For more information about lupus please visit Lupus UK’s website and if you are concerned about any symptoms you may have, visit your GP.

October is Breast Cancer Awareness Month and this infographic by the Cancer Treatment Centres of America tells you everything you need to know about breast cancer.