Tomorrow, June 19th, is also known as Juneteenth. This holiday marks the date in 1865 when Union soldiers arrived in Galveston, Texas to inform enslaved Black people that slavery had formally been abolished, nearly 3 full years after Lincoln's Emancipation Proclamation in September of 1962. While the day has been recognized as an official state holiday in Texas since 1980, it is increasingly observed throughout the country and activists are pushing for Congress to make it a national holiday.
As activism surrounding antiracism has seen a reinvigorated effort, particularly over the past year, and Juneteenth becomes ever more widely recognized and celebrated, we felt this week's Feature Friday was an especially necessary time to address white privilege in breast cancer. White and Black women have similar rates of breast cancer diagnosis, 13% and 12% respectively (Susan G. Komen), yet Black women are nearly twice as likely to die from breast cancer (Cancer Cytopathology). This disparity is truly an outrage. In the articles below, we explore the inequalities and structural racism that have led to this, as well as the work that researchers and doctors are doing to change this.
As always, let us know your thoughts and how you’d like to contribute to the discussion.
Chicago's Center for Community Health Equity, a partnership between Rush University Medical Center and DePaul University, is pairing medical researchers with social scientists to take a more holistic approach to identifying and removing barriers to cancer care. A collaborative approach, Dr. David Ansell says, can help to zero in on often invisible but important variables such as differences in the quality of care by race.
In addition, poverty and isolation can knock out critical social supports that help patients to get through medical treatments. For minority communities, one key difference is the way in which poverty is concentrated within specific neighborhoods. In Chicago, Dr. Ansell says, women who are poor, are minorities, or are on public insurance are 40% less likely to live near a breast-imaging center of excellence than their white counterparts. Instead, hospitals and clinics that serve minority neighborhoods are often underfunded and unable to keep up with advances or new recommendations. Read More.
In 1995, The Black Women's Health Study (BWHS), a partnership between Boston University and Howard University's medical schools, launched as the largest ever long-term study of the health of Black women. Today, the study, the nation’s largest and longest running examination of black women’s health, is still going.
One finding of the study is that Black women are more likely than women of other races to be diagnosed with difficult-to-treat ER-negative breast cancer. Researchers, however, are still trying to understand why. Data from the study is now being used to examine both the genetic factors at play, as well as uncover which environmental factors might be most potent at tipping the breast cancer odds. Carrying extra fat around the middle, getting pregnant for the first time later in life, having more children, and forgoing breastfeeding are all linked with a higher risk of getting ER-negative breast cancer before age 45. Epidemiologist Kimberly Bertrand is encouraged with this discovery, as breastfeeding and body fat percentages are potentially modifiable behaviors. Read More.
Leanne Pero is the founder of Black Women Rising, a support group for Black women with breast cancer. In this interview with Glamour magazine, she addresses the challenges she and her peers have faced throughout their experiences with breast cancer. The racial bias and lack of support come from all sides- both from medical professionals and from family and friends.
A 2016 study found that many medical students were approaching their patients with an underlying and unconscious bias that influenced how they measured and distributed pain relief. Leanne recounts "A sad story came through one of our support groups, recently. One of our ladies had been told her hospital was providing holistic treatments for cancer patients. But when she went to access it, she was told it wasn't for her. Only when she pointed out that she was a person going through cancer [exactly who the holistic treatment was designed for] was she offered it, reluctantly." While that's just one example, Leanne says those kinds of attitudes are typical.
Leanne goes on to say how there is a sense of shame around cancer diagnoses for Black women. “Black women have been told cancer ‘isn’t a black disease’ or that it’s karma or a curse for something we’ve done in the past. The worst thing is lots of women have been told not to get chemotherapy or life saving drugs, because it’s ungodly.”
She hopes that by creating open and encouraging conversations about breast cancer among Black women, she can help change the culture and some of the stigma around seeking treatment and social support. She wants other Black women to feel represented in the breast cancer support community. Read More.
Some hospitals hire navigators to help guide poor and minority women through the process of breast cancer diagnosis and treatment. Equal Hope, an organization in Chicago (formerly the Metropolitan Chicago Breast Cancer Task Force), is one such group of navigators. Equal Hope offers uninsured women free access to primary care doctors and to breast and cervical cancer screenings, plus follow-up care if needed.
Retha Cooper is one of these nurse-navigators and reaches out to patients whenever they receive an abnormal mammogram. “Community hospitals can do mammograms and simple biopsies, but they’re not equipped to do chemotherapy or radiation,” Cooper said. “It’s my responsibility to make sure they’re followed up in a timely manner, and to encourage them to have any follow-up treatment in a comprehensive cancer center.”
Chicago is one of the most segregated cities in the US, and has historically had one of the worst disparities in breast cancer outcomes between Black and White women. Equal Hope's Executive Director, Anne Marie Murphy, cites the higher levels of stress and pollution that Black Chicagoans face as a key contributor to their higher rates of health problems. Starting with breast cancer, Equal Hope aims to close this racial health gap. The disparity of breast cancer death rates in Chicago is now down from 62% in 2008, to 32%, which is well below the national average of 43%. Murphy believes Equal Hope's model can be applied to other American cities with large Black populations. Read More.