By Kimberly Stephenson
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 give access to the more realistic and honest approach to it. 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.
SCREENING
In Part I of Kimberly’s Korner, we are talking Disparities in Breast Cancer Screening. Breast cancer currently affects more than 1 in 10 women worldwide. The chances of a female being diagnosed with breast cancer during her lifetime has significantly increased from 1 in 11 women in 1975 to 1 in 8 women[1]. Fortunately, the mortality rate from breast cancer has decreased in recent years due to increased emphasis on early detection and more effective treatments. Although the mortality rates have declined in some ethnic populations, the overall cancer incidence among African American and Hispanic population has continued to grow[2].
Much of the contemporary understandings of access and treatment of breast cancer has been through analyses of predominantly white, middle-class women. Women of color, specifically black women, are rarely studied as social entities in and of themselves. And yet we know that race, social class, ethnicity, gender, sex, religious affiliation and more collectively shape differences in a breast cancer patient’s experience of the healthcare system. No two breast cancer stories are identical, but for reasons, which I will explain in this series, there are gaps in both access and treatment for communities of color.
Disparities in screening mammography are decreasing among medically underserved populations but still persist among racial/ethnic minorities and low-income women. There are a host of differences in experiences and lifestyle that put African American women at greater risk to have a deadly more advanced stage of cancer, and in many healthcare systems those unique factors go unnoticed. According to a 2015 study done by the American Cancer Association, “advances in diagnosis and treatment that have sharply improved survival rates from breast cancer and saved countless lives have largely bypassed African American women”[3]. No matter what the measure is, African American women are at a substantial disadvantage when dealing with breast cancer.
Mammography screening is important for all women, regardless of their race/ethnicity or their risk of breast cancer. Along with follow-up tests, and treatment if diagnosed, mammography can reduce the chance of dying from breast cancer. However, Black women are often diagnosed at a young age when the disease tends to have the worse prognosis. The racial disparities gap in breast cancer diagnosis, mortality, and survival have continued to widen in the U.S. between White women and Women of color.
For example, between 2008 and 2012, the median age for women diagnosed with breast cancer in the U.S. was 61 years. The median age was lower for Black women (58 years) than white women (62 years). Also, during that same period, breast cancer mortality rates were almost 43% higher in Black women than white women. The median breast cancer death age for all women was 68 years, but 69 years for white women, and 62 years for Black women[4]. So, in most cases Black women are diagnosed earlier and die earlier from breast cancer.
Meanwhile, incidence and death rates for breast cancer are lower among women of other racial and ethnic groups than among non-Hispanic White and Black women. Asian/Pacific Islander women have the lowest incidence and death rates. But what are the actual reasons behind the disparities behind breast cancer screenings among racial and ethnic groups?
Whereas common patient-related obstacles to breast cancer screening include perceptions of mammograms (being seen as painful) and fear of negative or unreliable results, communities of color face different ones. Factors like[5]:
(1) low socioeconomic status;
(2) specific biological characteristics of the tumor...;
(3) younger age at diagnosis (younger than 45);
(4) multiple coexisting medical conditions, particularly for older women;
(5) delay in diagnosis and treatment;
(6) treatment differences; and
(7) differences in access to early detection and prompt treatment
Even with free or low-cost screenings, African American women partake in screening programs at lower rates than their white counterparts. And now, with the incidence rate leveling out between both African American women and white women, it is even more important to recognize the perceptual and motivational factors that dissuade an African American woman to go in for a screening. It is interesting to compare the two perspectives; on one hand white women are not participating, or hesitate to participate in, breast cancer screenings for reasons that are seemingly medical or biological. Whereas, women of color tend to stray away from breast cancer screenings because of more cultural and relational reasons.
The fifth factor, delay in diagnosis and treatment, will be discussed in Part II of this series. It is also the leading cause for Black Women being the number one group with advanced stage cancer upon first observance. All the above factors are some reasons why communities of color are, by and large, at a disproportionately disadvantaged stance when dealing with breast cancer from screening to survivorship.
[1],[2] Yedjou CG, Sims JN, Miele L, et al. Health and Racial Disparity in Breast Cancer. Adv Exp Med Biol. 2019;1152:31-49. doi:10.1007/978-3-030-20301-6_3 [3] https://ww5.komen.org/BreastCancer/DisparitiesInBreastCancerScreening.html [4] Williams F, Thompson E. Disparities in Breast Cancer Stage at Diagnosis: Importance of Race, Poverty, and Age. J Health Dispar Res Pract. 2017;10(3):34-45. [5] Bradley, Patricia K. (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.
About the Author:
Kimberly Stephenson is a MPH Candidate at Boston University School of Public Health studying Health Communication and Promotion with an concentration in Maternal and Child Health. Kimberly currently works at BMCHP HealthNet Plan as a Senior LTSS Coordinator and will be joining SurvivingBreastCancer.org as the Marketing and Communication Intern. Kimberly has worked for other Breast Cancer Foundations in the past and is passionate about the health disparities among women and minority populations both globally and domestically. Kimberly was born on the small island of Dominica in the West Indies and enjoys travelling, gardening and is an avid foodie!