Today’s Topic : Long-term survival with breast cancer is a cultural as well as medical issue.

When breast cancer is discovered early, a patient has a 93% chance of living at least five years, according to the latest figures from the American Cancer Society. Yet that statistic doesn’t apply equally to all women.

When broken down by race, the data paint quite a different picture. Between 1983 and 1989, for example, 81% of white women had a five-year rate of survival, regardless of when their breast cancer was discovered. That number dropped to 64% for African American women, according to American Cancer Society figures.

There is no known medical reason for the difference. Rather, economics, culture, language, even sexual orientation are proving to be just as much a barrier to overcoming breast cancer as anything found under a microscope.

“For many groups, this is partly due to a lack of information and lack of access to the health system,” says Dr. Mercedes Brenneisen-Goode, an oncologist practicing in Los Angeles. “They don’t have the money to spend to get a mammogram, they are more worried about day-to-day living.”

Cultural barriers to getting timely medical treatment and the outside support that many believe is vital to recovery can be just as daunting.

In today’s Community Comment, support group pioneer P.J. Viviansayles talks about the frustration she felt as an African American who had nowhere to turn for support when the disease was diagnosed. She also discusses the social difficulties faced by African American women with breast cancer.

Medical professionals are beginning to understand that treatment may need adjustments from one culture to another. “The first thing we learned was that the same approach wouldn’t work” for all patients, says Dr. Dava Gerard, medical director of the Breast Health Center in Santa Ana. “Our slogans weren’t reaching groups of underserved women,” adds Gerard.

Some problems are specific for each culture. “For many of the Hispanics I see, it’s not part of their culture to go to the doctor for prevention,” says Brenneisen-Goode, who also practices in Glendale. “They wait until they’re very sick and then they tend to go to local pharmacies for advice. Possibly, they feel a little shy to go to a doctor.”

Two groups that often fall between the cracks are the physically disabled and lesbians. “Lesbians are more likely to develop breast cancer because they have many high risk factors, but they are uncomfortable dealing with a homophobic medical community,” says Gerard. “And the physically disabled often have difficulty getting a wheelchair up to a mammogram machine.”

Gerard says some barriers are universal. For instance, women without a family history of the disease often wrongly believe they are safe from breast cancer.

The cultural problems surrounding breast cancer are real, say these progressive physicians, and only by being acknowledged can they be overcome.