Kimberly’s Korner: Investigating the Health and Racial Disparities in Breast Cancer (Part III)
Background: There seems to be a gap in both access and treatment for black women when it comes to breast cancer treatment, and I am interested in understanding why that is. There are many reasons as to why I choose this topic; firstly, having a grandmother who has battled breast cancer twice. Sadly, it was not until I was well into adulthood that I truly understood her experience and her illness and the way in which my family, an immigrant family at that, viewed her treatment process. Secondly, interning for a few Breast Cancer advocacy groups has allowed me to push aside my cultural perception of cancer and illness, and take on a more realistic and honest approach. In this 3-part series (Screening, Diagnosis/Treatment, and Survivorship), I aim to guide you through the screening process all the way to survivorship, and the barriers that black women may encounter when diagnoses with Breast Cancer.
In Part I and Part II of the three-part series of Kimberly’s Korner, we delved into the health disparities for women of color from screening to diagnosis and treatment when dealing with breast cancer. This series touches the surface as to why there are racial and ethnic disparities in breast cancer access and treatment for African American women; explaining how differences of outcomes in each stage of the breast cancer journey vary. In the screening stage, factors like race and social class are more pervasive. But in the diagnosis/treatment phase, barriers like age and ethnicity shape it. And lastly, surviving cancer encompasses more of the African American woman’s family, gender, and religious affiliation.
There are cultural variations in the ways in which individuals of different communities and societies handle oppression, grief, and illness. Another obstacle, less medical, that African American women with breast cancer must overcome is coping. Coping with the diagnosis of breast cancer can be a task lasting forever—even after survivorship. Historically, African American women would have never been able to survive under the dangers of slavery, colonization, genocide, etc. had it not been for their creativity with coping skills. A huge part of coping with surviving breast cancer for African American women is building a community.
The biggest and most documented coping skill of African American women in response to breast cancer diagnosis or recovery is spirituality and religion. Not only is religion and spirituality used for coping an illness, it is also used to manage any adversity. Most women of color view health holistically; which includes “spiritual, moral, somatic, physiological, psychological, social, and metaphysical dimensions” (1). Many surveys and studies have found that for a large majority of African American women, their faith in God and their health behavior were inseparably coupled. To many, God was said to have been the reason to that they go and see doctors as well as how well the doctors succeeded in their treatments. This study also found that African American women expressed a belief in effective coping skills to be grounded by five pillars: self, God or nature, family and friends, other survivors and the health care treatment team (2).
Communalism is also a part of the African tradition. Central to African American women’s survival is family and friendships; a genuine sisterhood of bonding that promotes self-acceptance and provides emotional support used to relieve everyday stresses. Most African American women “seek help from extended family members, very close family friends ministers, and church leaders…Quite often, only after exhausting available inner, familial, and spiritual resources does the person seek medical advice” (2). This goes back to the idea that there is a disconnect between African American women and healthcare providers and the healthcare system. But this also helps us to understand just how African American breast cancer survivors view themselves. Culturally, African American women are usually the caregivers in their homes and communities, so for them going through this illness, and overcoming it, can have a tremendous effect on how they decide to live their lives. The common saying, ‘strong black woman’ is internalized and often times African American women go above and beyond to live up to it.
Breast cancer is dealt and perceived somewhat secretly in the African American community. Although African American women strongly believe in communities and having support when she deems it necessary, there is still a code of silence among survivors and fighters. Breast cancer survivors, after battling and beating the disease, view themselves in a completely different light. An African American woman’s perception of herself through her detection and her treatment of breast cancer is one phase, but through and after the battle, she goes through another. In the novel, ‘Wings of Gauze: Women of Color and the experience of Health and Illness’, editors Barbara Bair and Susan Cayleff bring up concepts that are not usually talked about in the African American community regarding breast cancer. Issues concerning the sense of her own body, her womanliness, her role as a caregiver, and her romantic relationships. This hesitation of unfamiliar dependence and vulnerability plagues the community.
The Bair book also introduces Audre Lorde into the narrative of breast cancer and endurance. It allows for readers to be enlightened by the debate about the feelings that having cancer provokes in women of color and the sometimes-false meaning that we attach to them. With Audre Lorde having been a victim to breast cancer herself, her essay presses women of color to ‘break the code of silence’ surrounding the issue of cancer, to question the sense of helplessness and indifference that characterizes women of color’s response to the disease and to confront the risks and speak out about them.
Admittedly, there are similarities but the differences in survival between African American women and other communities are credited to many factors. All too often society looks to socioeconomic status, access to healthcare, poverty, and education level as the offenders in answering the questions that regard poor African American women’s health status. Not to say that these factors are not contributing to African American women’s ill health. There is a large population of people who are still uninsured, and a large portion of those people are African Americans. When this fact is coupled with the blatant historic racism that African Americans face, a recipe for compromised health status arises.
From Audre Lorde’s Cancer Journal to the breast cancer activism of the 1990’s and 2000’s, the notion of health disparities used in public health initiatives and programs has been a topic of discussion. A call for new approaches to close the gap of racial and ethnic inequalities in breast cancer access and treatment is necessary. These strategies and approaches are needed to promote breast cancer prevention, improve survival rates, lower breast cancer mortality, and ultimately improve the health outcomes of racial/ethnic minorities. Furthermore, it is imperative that leaders and medical professionals from minority population groups be included in decision-making research so that racial disparity in breast cancer can be well-studied, fully addressed, and ultimately eliminated in breast cancer al together (3).
(1) Saint- Germain, M (1993). Resignation and Resourcefulness: Older Hispanic Women’s Responses to Breast Cancer. In Wings of Gauze: Women of Color and the Experience of Health and Illness. Barbara Bair and Susan E. Cayleff, eds. Pp 257-272. Detroit: Wayne State University Press.
(2) Bradley, P. (2006). Breast Cancer in African American Women. In African American Women’s Health and Social Issues. Catherine Collins, ed. Pp 36-42. Westport: Praeger Publishers.
(3) Yedjou, C. G (2019). Health and Racial Disparity in Breast Cancer. Advances in experimental medicine and biology, 1152, 31–49. https://doi.org/10.1007/978-3-030-20301-6_3