women of colour & breast cancer
I think we all know breast cancer as being highly pervasive and traumatic; what we usually overlook is the fact that it transcends geographical, racial, and socio-economic boundaries. In the fight against this relentless disease, early diagnosis and appropriate representation in research and healthcare are vital. However, women of colour, particularly Black and Brown women, face significant disparities in both aspects, which hinder their ability to live with and/or survive breast cancer. In this blog post, I’ll delve into the reasons behind the underdiagnosis and underrepresentation of women of colour, examining the statistics that underscore these disparities, and explore potential solutions to bridge those gaps.
Disparities in Diagnosis
Early detection of breast cancer is a critical factor in improving the chances of survival and successful treatment. Mammograms and regular screenings play a pivotal role in identifying cancer at its earliest, most treatable stages. However, women of colour often face obstacles to timely diagnosis.
For many women of colour, socioeconomic disparities can create barriers to accessing quality healthcare. According to the American Cancer Society^, uninsured or underinsured individuals are less likely to receive routine breast cancer screenings, leading to delayed diagnoses. Within the UK, it has been well documented that GP’s routinely undermine the pain of Black and Brown women^. Studies show that the tendency for healthcare professionals to not believe WOC when it comes to routine breast cancer concerns or screenings leads to an under diagnosis or misdiagnosis almost 44% of the time. It took me until my initial tumour had grown outward of my breast, was 70mm in diameter, and the pain was unbearable to be taken seriously and rushed for observation.
Cultural factors and stigma may discourage women of colour from discussing their breast health or pursuing screenings. These factors can create a climate of silence and fear that further perpetuates disparities in diagnosis. It’s important to be respectful of people’s cultures and religions when practicing healthcare; I believe the government and the NHS have a duty of care to recognise our diverse population and create an open and safe dialogue when working on a solution for upping breast cancer screenings for Black and Brown women. Instead, it seems they are brushed under the rug, or dismissed when they raise concern.
This lack of education within the medical field plus the race based dismissals are actively contributing to the death of Black women with breast cancer. There are real world consequences of this negligence, and it’s astounding to me that the government, NHS, or any of the well-known breast cancer charities aren’t speaking up about this every single day. According to the National Cancer Institute:
Black women are more likely to be diagnosed with breast cancer at a younger age and at a later stage
Black women are 40% more likely to die from breast cancer than white women
While research on breast cancer disparities in Brown women is limited compared to that in Black women, it is vital to acknowledge that these disparities also exist. This is partly due to insufficient research- when this conversation first started around 40 years ago, the conducted studies looked at white vs Black women as it was deemed “easier” as a starting point. I don’t think I need to delve into how problematic that is in itself! The consequence of this was limited research, and limited action. In a journal by Dr Sarah Townsend^, she stated that the biggest considered factor when researchers initially undertook this, was that the majority of Brown women facing breast cancer in the UK were (at the time) first generation immigrants whose English was “less advanced” than their Black counterparts. I guess it’s a sign of the times that scientific research was dictated by whether you were racially favourable or not. I guess it’s a sign of the current times that this hasn’t been corrected in the big old year of 2023.
Under representation in clinical trials for breast cancer is a huge issue. According to the American Cancer Society, Black women are underrepresented in clinical trials, making up only 7% of participants. This underrepresentation limits the generalisability of findings to diverse populations. More money and research needs to be pumped in to clinical trials exploring breast cancer in women of colour only. Genetic disposition needs to be further understood in order to ensure the highest possible survival rate for marginalised women.
Genetic research into breast cancer has uncovered various risk factors and susceptibility genes. However, much of this research is primarily based on the genetics of white populations. As a result, women of colour are not receiving accurate risk assessments, impacting prevention and early detection strategies. We know that there are certain risk factors that disproportionately affect women of colour, so it’s crucial that we undergo clinical trials and genetic research in a bid to explore if there is anything else that could lead to a possible early detection, or treatment.
It goes without saying that the lack of inclusion has consequences for treatment options. Personalised therapies and targeted medication may not be as effective for women of colour if research does not include a more extensive range of genetic backgrounds.
Not only is it vital to life, but it’s also vital to living. Living with breast cancer is like treading quicksand as it is, throw in trying to live with quality of life and you’ve got yourself a whole new ball game. We, as women of colour, need to know how cancer will affect our hair, our skin, our hormones, our relationships. There are so many other aspects of life we need to bear in mind when we think of cancer therapy. Things like mental health and family relationships are different for women with a possibly different cultural or religious background. We often hear cliche phrases like “my whole world came rushing down” on those uncomfortable cancer TV ads; now imagine that plus being marginalised, and maybe even isolated for being marginalised.
Solutions:
It’s so important to expand national health campaigns and resources and increase health insurance coverage; it can help ensure that more women have access to regular screenings. Investing in community outreach programs can help educate and raise awareness among underserved communities (looking at areas which are densely populated by poc and funnelling in resources, talking with religious places of worship, etc). Reducing barriers to accessing healthcare facilities and providers can improve early detection rates - it’s all very easier said than done, I appreciate this, but we can start introducing such topics into sixth forms, colleges, universities, and hope that reaching places of education with a diverse reach can help to grow the seed for breast cancer education to all.
Healthcare providers should receive training in cultural and religious competency to better understand the unique needs and concerns of women of colour. Building trust and communication with patients can encourage more open discussions about breast health. Staff should also be regularly and randomly screened for racial bias within the healthcare setting. This is something I’m super passionate about, having been subject to both medical racism and racism within the workplace during my time at the NHS.
Breast cancer awareness campaigns must be culturally sensitive and inclusive. This goes for those brand who love to flaunt a pink product every October, yet only show up with one body type and one skin tone. Engaging with community leaders, influencers, and organisations within marginalised communities can amplify the message of early detection and regular screenings. Oh, and, creatives and cancer patients should be compensated for their time and trauma… with money, not free products. The least you can do in exchange for good PR is to pay the person sharing their experience, not only as a woman, but a woman of colour. Bloody ‘ell, if I have to say this again next year I think I’ll have to start naming and shaming. Brands, take this as your 1 year warning to get your shit together (I’m smirking right now, but not in a fun way, in an evil and vindictive way).
A note to sign off before my heart rate goes through the roof lol
Breast cancer doesn’t discriminate, but our healthcare systems do. Black and Brown women are disproportionately and continually underdiagnosed and underrepresented. Disparities in diagnosis and research participation perpetuate inequalities in healthcare outcomes. The real world consequence of this is that women of colour are dying, quite possibly unnecessarily.
The path forward requires a collaborative effort. Policymakers, healthcare providers, researchers, and community leaders must work together to dismantle the barriers preventing women of colour from accessing timely and effective breast cancer care. By addressing these disparities head-on, we can ensure that every woman, regardless of their race or background, has the best possible chance against breast cancer, or at the very least, has SOME quality of life for however long is left.
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References:
American Cancer Society. (2023). Breast Cancer Facts & Figures 2023-2024
National Cancer Institute. (2022). Cancer Stat Facts: Female Breast Cancer
Dr Sarah Townsend & Dr Adrian Nichol-Bar for The University of Sheffield (2015). Race Does Not Determine the Value of Breast Cancer Clinical Research