Busting Loose: Cancer Survivors Tell You What Doctors Won't

Ignorance and Poverty Are Carcinogens (Excerpt from Busting Loose)


Socioeconomic factors, such as access to healthcare, education and income—and not race—are predictive of how likely a woman is to die from breast cancer. -Chaundre K. Cross, MD, of Harvard Medical School


Impoverished women are often blamed for turning a blind eye to cancer symptoms until it’s too late. Sometimes these women don’t know anything about breast cancer. Others simply don’t have a doctor. Unbelievable as it seems, both still happen.

In addition, impoverished women often won’t visit a medical office until they are too sick to be helped because they believe a doctor won’t listen to them. When the self-esteem is injured by poverty and lack of opportunities in life, it’s easy to assume that authority figures (such as doctors), will shame and ridicule. It makes complete sense, on one level. Criticism and ridicule have followed these women all the days of their lives—so why should they believe cancer will change anything?
In the comparatively wealthy area of San Francisco where I used to live, 80 percent of breast cancer diagnoses are made in the early stages. Go north ten miles, to a neighborhood like ghetto-ridden Hunter’s Point, and only 40 percent are early stage cancers. The mortality rate is much higher in these neighborhoods, mostly because the disease has advanced further before treatment.

This holds true all over the United States and the problem gets worse as the disease progresses. Those who are under-treated for cancer pain fall into one of two groups: racial minorities and the elderly. There are medications available to help these patients. But they don’t get them or even hear about them. Many also receive sub-optimal treatment, to the point where their chance of survival is minimal.

Most women who live in poverty are high achievers and have more inner strength—need I even say this?—than a hundred wealthy women. They don’t employ others to manage their homes or children; instead they are typically the sole caretakers of a large, extended family. In particular, impoverished minority women are the ultimate earth mothers, taking in their terminally ill father, grieving the untimely death of their mothers, while surviving job loss and depression. (For one of my friends, all that happened before she reached age twenty-seven.)

We live in a world where the voices of the poor are seldom heard. Where minority women have to plead and scramble for every crumb of attention. It’s no wonder these women fear being ignored or considered a whiner or complainer if they ask a doctor to check on something as “apparently commonplace” as a lump in their breast?

The upshot of this unequal situation is that social and economic status is one of the biggest factors in determining breast cancer survival. For example, African-American women have the highest death rates from breast cancer of any ethnic group in the United States. But research shows that there is nothing in their genetic background that causes the discrepancy. In fact, black women are actually less likely to be diagnosed with cancer than Caucasian women. And when African-American women receive appropriate medical treatment their survival rate is at least as good as that of Caucasian women. No, it is the disparity in the time of diagnosis and treatment afterwards that causes the difference in mortality rates.
The terrible impact of poverty and lack of education on breast cancer mortality impacts women from all cultures. In the Hispanic community, promotoras often try in vain to help women become less secretive about breast lumps. These health educators focus on Hispanic women of lower socioeconomic status, because among these groups a breast self-exam is often considered improper. In addition, Hispanic women who have entered the country illegally often fear they will be reported to immigration if they seek medical help in the United States. The result is that the death rate from breast cancer is rising faster for Hispanic women than for any other female ethnic group.

Organizations such as the Susan G. Komen Breast Cancer Foundation are putting millions behind the effort to reduce the inequalities in screening and treatment access. A national program offered by the YWCA (Encore Plus) reaches out to women who face obstacles to breast and health services. Encore provides free mammograms, advocacy and referrals, as well as information and support services for breast cancer survivors in English and Spanish.

In addition, the U. S. Centers for Disease Control and Prevention (CDC) runs the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The program provides breast and cervical cancer screenings and treatment to low-income women. All 50 states offer these services NBCCEDP, since 2000 when the Breast and Cervical Cancer Treatment Act passed. If a woman gets a mammogram through this program, and it turns out she has breast cancer, the NBCCEDP can pay for her treatment, too. And as of May 2004, all 50 states and the District of Columbia have passed legislation to provide free treatment through the program as well.
To get breast cancer care through the program, you must: get your mammogram through the CDC NBCCEDP and need treatment for breast cancer (You qualify if your mammogram shows a pre-invasive condition, too), not have health insurance that covers breast cancer care, not qualify for the Medicaid program in any other way, be under age 65 (so that you can't get Medicare), and be a U. S. citizen or a "qualified alien."

There are additional programs and organizations listed in the “Helpful Organizations Glossary,” at the end of this book. Many programs offer free medicine, free long distance travel, free or low-cost care at certain centers and free breast cancer screening. Programs such as these are trying to reduce the disparity, but much more could be done. Equal access to quality breast cancer care remains a huge problem.