1. THE CANCER GAP: Rebecca's story
BYLINE: PATRICIA GUTHRIE; Staff
DATE: September 29, 2002
PUBLICATION: Atlanta Journal-Constitution, The (GA)
EDITION: Home; The Atlanta Journal-Constitution
SECTION: Features
PAGE: LS1
MEMO: The second in an occasional series examining Georgia's efforts to reduce
cancer deaths. Today: Rebecca Simpson's story.
What if a doctor had recommended an annual mammogram?
What if a friend had simply explained how to do a breast exam?
What if there had been health insurance? A paycheck? A car?
She sits and stares. Sits, stares and spins through a familiar list of what if, what if?
Everyday life grinds on below her small apartment balcony overlooking North Avenue.
Honking cars. Sputtering buses. Bits of breezing-by conversation.
It's a perfect sunny Atlanta day, but not one she can truly enjoy. The reason is etched in
X-marks on a wall calendar in her living room. On every month since December, the
17th day has been crossed out with a pen. January, February, March, April, May, June,
July, August. How many more months? How many more calendars?
"It's cancer. It's death," Rebecca Simpson says, still reeling from the breast cancer
diagnosis that changed her life last year. "It's automatic. You just think you're dying
when they tell you it's cancer. But on the 17th of every month, the day of my surgery, I
thank God I'm still alive."
She can't know what will be. She can't guess what might have occurred if so many
things had been so different: her bank account, her health care, maybe even the color
of her skin.
All she knows for sure is what it says on her medical file: African-American female, 61,
breast cancer. And because the tumor had spread to her lymph nodes and was
discovered late, she must live with the knowledge that the odds aren't as good as they
would have been had the cancer been caught in its earliest stages, when it's 96 percent
curable.
"I thought it wasn't anything I'd have to deal with," she quietly reveals. "Of course, I've
heard about it, read about it and seen it on television. But since no one in my family
ever had cancer, I didn't think about it. I thought I was exempt."
Last October, Simpson learned what some 33,000 other Georgians find out every year:
No one is immune to cancer.

2. Her journey began with a weird bump under her right arm. She happened to have a
mammogram scheduled that week. She hadn't undergone the X-ray procedure --
recommended annually for women over 50 -- since 1997, when she lost her private
health coverage and her full-time job.
The tumor turned out to be relatively small -- usually good news. Eight days before
Christmas, Crawford Long Hospital surgeon Brian Organ removed her right breast, then
made a disheartening discovery. Seventeen of 20 nearby lymph nodes contained
cancer.
The general rule: Survival decreases as the number of cancerous nodes increases.
Simpson says her doctors have yet to answer the Big Question.
"When I asked my surgeon, 'Did you get all the cancer?' He told me, 'Well, Miss
Simpson, I got all I saw,' '' she says. "They never did tell me my chances of survival."
Cancer is the second-leading cause of death in Georgia and the United States, behind
cardiovascular disease. Blacks in Georgia are 27 percent more likely to die of cancer
than whites. In metro Atlanta, black women die from breast cancer at a rate 67 percent
greater than white women. Prostate cancer kills black men in metro Atlanta at a rate 182
percent greater than white men.
"In the United States, it is bad to have cancer; it is worse to be poor and have cancer;
and it is even worse to be poor, black and have cancer." -- Dr. Otis Brawley, Emory
University Winship Cancer Institute.
Rebecca Simpson is the rule, not the exception, when it comes to cancer. Odds
conspired against her even before her diagnosis.
In Georgia, as across the nation, blacks are at greater risk for cancer. They die more
often from breast, prostate, colon and pancreatic cancers, and they're more likely than
whites to receive substandard treatment.
Overall, blacks are 27 percent more likely to die from cancer than whites. No other race
or ethnic group is ravaged by cancer as much as African-Americans.
For decades, scientists suspected genetics might be to blame for the disparity. But
studies have shown that blacks are no less likely to survive cancer than whites, if
diagnosis, treatment and access to medical care are equalized.
Health experts cite many factors in the cancer gap: poverty, lack of health insurance,
lack of transportation to get to a doctor, inadequate access to cancer screenings or not
taking advantage of preventive measures.

3. Other variables may influence the statistical picture, including diet, environment,
lifestyle, distrust of doctors, fear that cancer is inevitably fatal and belief in home or
religious remedies.
Studies have also shown that blacks are more likely to suffer from heart disease, high
blood pressure and other diseases that can interfere with cancer treatment. They may
also receive inferior therapy in different stages of the disease when compared with
whites, studies show. Many cancer specialists believe the divide isn't simply a matter of
black and white. It's also a factor of economics: the haves and have-nots.
"Equal access to equal treatment leads to equal outcomes," is the mantra of Dr. Otis
Brawley, one of the nation's authorities on cancer disparity. Emory University's Winship
Cancer Institute recruited Brawley from the National Cancer Institute two years ago.
He'll lead a new cancer center at Grady Hospital that's designed to get at barriers to
care. Late diagnosis is known to be a major culprit in the black/white and rich/poor
cancer gap. Not having access to, or not taking advantage of, cancer screening greatly
affects chances of survival, experts say.
"The reason African-Americans die at a higher rate than Caucasians is we present
ourselves to the doctor at such an advanced stage of cancer," says Charlie Stayton,
executive director of the Witness Project, a health program designed to educate African-
Americans about cancer through churches and community centers.
Started in Arkansas a dozen years ago, the project has been replicated in 20 states,
including Georgia, through funding by the Centers for Disease Control and Prevention in
Atlanta.
"We need to take action. We just can't sit there hoping cancer will go away," stresses
Stayton, an 18-year survivor of cervical cancer. "Each day that we wait will possibly take
years off our lives."
Rural residents can be particularly stung by advanced-stage cancer, says Rita Salain of
the Southwest Georgia Community Health Institute. Based in Albany, the coalition is
developing a cancer attack plan for 38 surrounding counties. Its analysis of Phoebe
Putney Memorial Hospital data found 40 percent of all breast cancer patients were
discovered in late stages of the disease, and nearly two-thirds of Medicaid and
uninsured cancer cases had an initial diagnosis of cancer that had spread.
The largest number of uninsured cancer cases was among black females, ages 45 to
54.
"It's a poverty issue. It's an education issue. It's an availability of care issue," says
Salain. "We have way too many people down here with late-stage diagnosis. If we really
want to get a handle on cancer rates, we have got to diagnose earlier."

4. One in two males and one in three females will develop cancer in their lifetimes, most
after their 54th birthday. Every 38 minutes, someone dies of cancer in Georgia.
"Inherent in the diagnosis of cancer is loss of control, loss of hope, unwanted
aloneness." -- Jill Hall, cancer survivor, Georgia Cancer Coalition community liaison
Heat and humidity soar in Simpson's one-bedroom apartment on the second floor of the
Cosby Spear federal housing complex. Outside, a small ceiling fan loses the fight to
cool off her balcony. Sitting in a green plastic chair, floppy straw hat on her head,
Simpson watches sidewalk people she's come to know.
"Now, this man here, he runs every day," she says of the skinny white guy, swimming in
a shirtless sweat. "Not fast, but he runs."
She chuckles in a low lilt, lets loose in a full-throttle laugh. Her easy laughter, like her
breathy voice, contrasts her height, broad shoulders, sturdy build and round face. She
sounds more like her wide brown eyes look: joyful, friendly, sincere.
She's by nature a positive force. Smiling. Greeting. Long, pink fingernails. A high, lyrical
voice rising and falling like the hours of the day.
"How are you doing this morning?" she asks of a tiny elderly lady on the elevator.
"Doesn't it look beautiful today?"
Simpson's also quick on the draw with wry observations and one-liners. Take the time
she's in a fitting room, trying on a bra with a prosthesis: "I'll never get a man now," she
laughs. "They hardly love you with two breasts. With one, my chances are slim to none."
Gold hoop earrings. Jangling necklaces. Bands of bracelets. Whether out to see
another doctor or to meet a girlfriend for lunch, she's looking good, even if she's feeling
rotten.
Occasionally, there are other things Simpson wears as well: doubt, sadness, fear.
"My life really has so many voids in it. I don't have a companion. I don't have any
children. I don't have a close-knit family, and now this. You wonder. It makes you
wonder."
She's always been somewhat of a loner, she admits. But that's by choice, mind you.
Still, she opens up on the telephone to close friends and her ex-husband, a man she
divorced in 1982 after 10 years of marriage. "I called an old friend in Virginia, and she
asked me, 'Why you keep talking negative like you're gonna die?' I told her, I've lost so
many friends to cancer, it makes you think.

5. "One man I knew, he was healthy, jogging every day, and then his stomach just started
hurting. It was too late. He had colon cancer. He had surgery in March. By May, that
man was dead." But Simpson isn't competing for pity.
Sure, maybe her breast cancer would have been caught sooner if she wasn't poor, if
getting to the doctor was easier, if she had regular checkups, if a health worker saw to it
that Simpson received annual breast exams. But she also knows the cancer could be
worse.
"I can't feel sorry for myself," she says. "There's this 33-year-old woman with two
children I've gotten to know at treatment. They were going to give her chemo, but I think
she's too sick. She had cancer in one breast, then in came back on the other, and they
took that one too.
"I have lived almost double her life. That's why I don't complain."
Women on Medicaid are three times more likely to die of breast cancer compared with
women who have private health insurance, a recent Michigan State University study
found. In Georgia, about 3,200 patients a year diagnosed with cancer lack health
insurance.
"BreastTest and More [a state program] gives free clinical breast exams and Pap
smears to uninsured and low-income women. But with the funding we get, we can only
reach 14,000 women a year --15 percent of our target audience. The demand exists;
the dollars do not." -- Carol Steiner, director, Georgia Cancer Control program
Poor, black, living on the edge, Simpson personifies many of the challenges facing low-
income cancer patients. If it's not one barrier or hassle, it's another as she maneuvers
through the maze of doctors, therapy, side effects, bills and pills.
Take chemotherapy. She walked about a mile from her North Avenue apartment to
Crawford Long Hospital every three weeks.
That wasn't the hard part.
The two-hour procedure sometimes took six, seven, eight hours.
Because of the wait.
For blood lab results to come back, treatment rooms to clear out, lost orders to be
found.
"One day I went in for chemotherapy in the morning and came out when it was dark."

6. Simpson wasn't keen on receiving her treatment regimen at Grady Hospital because of
her past experience of long waits, and of being seen by physicians' assistants. It's also
not within walking distance of her home.
But she credits Grady for steering her to a relatively new state program called Women's
Health Medicaid. It extends Medicaid benefits to low-income women without health
insurance who need breast or cervical cancer treatment.
The program is partly funded by Georgia's share of the landmark settlement with
tobacco companies, but it barely covers the need.
Simpson found help at the nearby Northeast Health Center, affiliated with the Fulton
County Department of Health and Wellness. There, nurse Brenda Raper signed her up
for the new Medicaid and gave her the names of cooperating doctors.
When not going to medical appointments, Simpson spends her days surrounded by
reflections of her former life, when she had a full-time job and could afford the niceties
that make a space a home. A glass and chrome dining table, three TVs, wine glasses
sparkling from a small display cabinet, matching towel sets in the bathroom.
Hard times fell four years ago when Simpson's longtime federal government career
ended, temp jobs couldn't pay the rent on her southwest Atlanta duplex, and she went
through her savings. She didn't think she'd end up here.
"I just wanted some assistance to help me through. I didn't want it for the rest of my life,"
Simpson says. "The rent is the lowest it can be, $25 plus $9 electric bill and the phone
bill. All the other bills, I don't even bother opening."
She had paid $425 monthly rent for a couple of years at the federal housing complex
when she went back to full-time work. But that job ended, cancer began and new
worries set in.
She lives on her monthly $225 public-assistance check plus $135 in food stamps. Her
food stamp card looks like a credit card with an American flag sweeping across it. For
prescriptions, her co-pay is 50 cents.
She applied for disability payments based on her inability to work during cancer
treatment, but was turned down. An attorney is now fighting for her.
"Out of $225, I have to pay for toiletries, dish detergent, body soap and other items like
that. It doesn't last. At the end of the month, I have no money. Right now I'm drinking
Ensure for breakfast and lunch."
Cosby Spear is clean and well-kept, with security cameras and silk flowers at the
entrance, a new television sitting room and walls of colorful fliers announcing activities
and health screenings.

7. "Living here is a blessing," she says. "I would have had to move in with a friend without
it. I like living alone. I'm not homeless, and I have the dignity of having my own place. I
have the same quality of life as I had before, except without change in my pocket."
Simpson knows what it's like to be on both sides of the haves and the have-nots.
"I had Blue Cross and Blue Shield, the high-option plan," she recalls. "You can see the
doctors are going to give you the good care because they respect that insurance card.
They sure do.
"Without insurance, you don't go see a doctor as often as you should. Poor people are
struggling to survive. They're living day to day, they're worried about keeping a roof over
their head, and they're thinking of their family. They only think of going to a doctor when
they need it. The preventive side, they don't do too much of that."
Living alone only adds to Simpson's personal struggle.
Following her December surgery, three episodes of severe infections landed her back in
the hospital.
But first, she had to get to the emergency room.
"I was weak, throwing up, ran a temperature for four days. I felt really, really sick," she
remembers. "I didn't have money for a cab. But I'm a determined person. Somehow, I
crossed the street and got on the bus. I could hardly walk."
Comparing two groups of women with advanced breast cancer, Dr. David Spiegel of
Stanford University found that women who attended weekly support groups lived twice
as long as those who did not.
"They need to be talking to other people with cancer and sharing their stories, and to
hear, 'You can get through this.' They need to know people do survive cancer and that
they have a quality of life." -- Ameila Williams, head of social work for Grady Hospital's
oncology patients
Rebecca Simpson's umbrella snaps open as she strides up North Avenue's concrete
slope. Steady rain turns to drizzle by the time she cuts across the Publix parking lot on
the corner of Piedmont.
Ten minutes later, she arrives at the office of her medical oncologist, Dr. Laura
Weakland, near Crawford Long Hospital.

8. "I was going to cure myself through prayer and herbs," Simpson says, passing time in
the waiting room. "The doctors said, 'That's great,' but I needed," she stops in mid-
sentence, feigns a big sigh, " 'modern medicine.'
"So, I figured God put doctors here for us. But if I had the money, I'd go to Mexico."
Weakland checks out Simpson's complaints: the blood blister on her foot, the sores in
her mouth, the numbness in her arm. "Overall, I'm doing good," Simpson tells her. "I
don't know how the cancer's doing, but I'm OK."
"What cancer?" Weakland says, looking up.
"Yes, what cancer?" Simpson repeats the hopeful humor.
A dose of good news/bad news comes next.
No more chemo. But now it's time for radiation.
Simpson's face falls.
"You didn't tell me about radiation," she says, her high voice getting even higher. "That's
news to me."
Radiation had always been part of the treatment plan, Weakland responds. She gently
suggests maybe Simpson forgot what she was told during the initial anxious days of
diagnosis.
"Chemotherapy took care of any cancer cells that may have gone to other organs," the
oncologist explains. "What we're also worried about is under the arm because you could
have local recurrence. Normally, when you have a mastectomy, you don't need
radiation. But it's worrisome for someone who's had four or five or more positive nodes."
Simpson's glad to hear that mouth ulcers, bleeding gums and burning lips -- all side
effects of chemo -- will be a thing of the past. But what will radiation bring?
"It makes me feel that my cancer is kind of serious," she says, a shadow falling over her
eyes. But within seconds, her humor, her spirit returns. "But it can't make this scar any
uglier than it is," she says laughing.
That prediction turns out to be wrong.
Six weeks later, after daily radiation, the right side of Simpson's leveled chest is burned
charcoal black. A temporary condition, she's told, one that will clear up.
"I just can't believe this. Look at it," she says, carefully folding up one side of her blouse.
"It hurts so much. It's so painful, I can't even stand to put ice on it."

9. This year, 13,700 Georgians are expected to die from cancer. The total economic loss
from worker productivity and medical care due to cancer: $3.9 billion in the state; $160
billion nationally. Half of cancer medical costs are spent in a patient's last six months of
life.
"One out of two patients will not be here sitting talking to me in eight years. It's sad. I'm
never going to be out of a job." -- Medical oncologist Laura Weakland
Sometimes Simpson feels so good she forgets that she has cancer.
That it's with her for life.
Or death.
Other times, she wonders why there's so many people with so many kinds of cancers,
why scientists haven't figured out how to stop it, why they don't know yet what causes it.
"I didn't use to hear so much about cancer. What is it, in the food? Every time you turn
around, someone has cancer. Cancer, cancer, cancer, cancer, cancer.
"You wonder why," Simpson ponders one steaming summer day, shaded under her
balcony overhang.
"I was always trying to eat healthy. My grandmother taught me that. She cooked well-
balanced, nutritious meals.
"It doesn't matter. It made no difference."
Simpson steps inside to look through mail and papers on her phone table.
From the pile, she produces an invitation to the Celebration of Living 2002 conference,
held in early June.
She had looked forward to the half-day affair at the Cobb Galleria Centre. For the first
time, she wanted to reach out to others with cancer. Meet them, learn from them, hope
with them.
Sponsored by the Winship Cancer Institute, about 600 cancer survivors attended the
free workshops on topics ranging from nutrition and diet to healing and the human spirit.
A banquet lunch and appearances by Gov. Roy Barnes and Hamilton Jordan -- chief of
staff under President Carter and three-time cancer survivor -- were also featured.
Genetic screening, vaccines and the future of cancer research were themes extolled by
Barnes, who received a standing ovation.

10. But Simpson never heard a word. She couldn't get there.
"They said they had vans to pick people up so I called right away and gave them my
address but they never called back," she says. "It was supposed to make you feel good,
but now I feel bad, like I don't count.''
Organizers say it's possible she was inadvertently overlooked. But whatever happened,
it gives Simpson another moment to indulge in her insightful humor.
"Maybe my address gave me away," she chuckles, letting herself out her apartment
door before striding down the hall. "They knew I was poor people."
Waiting for the elevator, her gray, fuzzy head tilts back in a surge of delight.
"I'm going to call the governor," she declares. "That's what I'm going to do."
Then she's out the front entrance, headed for the bus stop.
Photo: During the visit, Simpson reads about her upcoming radiation treatment (above)./
PHIL SKINNER / Staff
Photo: Oncologist Laura Weakland of Georgia Cancer Specialists Simpson, then shows
Simpson how to do a self-injection (left)./ PHIL SKINNER / Staff
Photo: Without a car, Rebecca Simpson walked about a mile from her North Avenue
apartment complex (background) to Crawford Long Hospital every three weeks while
undergoing chemotherapy for breast cancer. She often returned by bus because of heat
and her fatigue. Her initial diagnosis took her by surprise, because there wasn't a family
history of the disease: "I thought it wasn't anything I'd have to deal with."/ PHIL
SKINNER / Staff
Graphic: ABOUT THE SERIES
The second in an occasional series examining Georgia's efforts to reduce cancer
deaths. Black men in Georgia die from prostate cancer at a rate 2.5 times greater than
whites, and breast cancer kills black women at a rate one-third greater than the rate
among whites. To address the disparities, the state has mounted the Georgia Cancer
Coalition, a 10-year effort to bring top researchers and new treatments to the area and
boost cancer screening and prevention efforts. Today: Rebecca Simpson's story. Read
the previous installment of this series and an interview with Gov. Roy Barnes on the
cancer coalition, and find additional cancer resources at ajc.com/living.
Aid rolls in for cancer patient
BYLINE: PATRICIA GUTHRIE; Staff
DATE: October 19, 2002

11. PUBLICATION: Atlanta Journal-Constitution, The (GA)
EDITION: Metro; The Atlanta Journal-Constitution
SECTION: Features
PAGE: C2
Rebecca Simpson couldn't believe what she was hearing on the other end of the phone
from her apartment manager. "Someone wants to pay my rent anonymously. My rent for
four months? You must be kidding."
No joke. Just one of many kind gestures Simpson has experienced since her struggle
with breast cancer and poverty appeared in The Atlanta Journal-Constitution last month.
Bouquets of pink roses, sweetly handmade get-well cards, many prayers and a warm
welcoming reception at a breast cancer fund-raiser.
"The outpouring of concern, compassion and thoughtfulness has been overwhelming,"
she said.
Simpson, 61, counts her blessings on the 17th day of every month. She underwent a
mastectomy Dec. 17. The cancer had spread to nearby lymph nodes, and she
underwent chemotherapy and six weeks of radiation.
Some of the dozens of people touched by her plight have had their own struggles or
watched loved ones succumb to breast cancer.
"Rebecca, I am afraid, is only the tip of the iceberg," wrote Carol Brantley of Midtown, in
a letter to the AJC. She said her recently deceased sister experienced the extra burden
of long, uncomfortable drives to hospitals from a rural home but had plenty of family
support, which Simpson lacks. Cynde Godfrey, a registered mammographer, said she
hopes Simpson's story reminds women of the importance of annual breast exams. "I
have seen so many women in Ms. Simpson's situation," Godfrey wrote in an e-mail.
"Many women lose their health insurance due to job losses and put their health care
last."
Simpson receives care through Georgia's Women's Health Medicaid that extends breast
and cervical cancer treatment to low-income women who are uninsured or
underinsured.
Simpson said her phone started ringing at 8:30 a.m. Sept. 29, the day the story
appeared. It was the first of many offers to help with errands and rides to medical
appointments.
She's received offers of financial help, groceries, gift baskets, and a quilting guild wants
to stitch her a "loving quilt." Car rental employees at Budget, where Simpson formerly
worked, posted a notice for donations. Another offered to give her earnings from

12. Tupperware parties. And students and teachers at Sequoyah Middle School in Doraville
raised $500, decorated cards, wrote poems and invited her to visit.
"I've got to go out there and hug every one of them," Simpson said with a laugh.
Photo: Rebecca Simpson's battle with breast cancer was featured in a Sept. 29 story.