Sunday, October 29 at 7:30PMIn a nation where one out of eight women will be diagnosed with breast cancer in her lifetime, (1) the issue of breast health demands the attention of both men and women. Minority women have particular reason to be concerned with breast health. Despite having lower incidence rates than whites, minorities have disproportionately high rates of mortality. Early detection greatly increases the odds of survival; however, common misconceptions and social and economic barriers prevent many women from information about the benefits of monthly self breast exams and access to annual mammograms.
Although the rate of breast cancer among African American women is 25% lower than those of Caucasians, the mortality rate is 30% higher. (2) A definitive cause for this disparity has not yet been determined; however, late detection is widely believed to be a significant factor. Many African American women do not receive regular mammograms for a variety of reasons. Among them is the perception that a diagnosis of cancer means inevitable death, a perception that could be fed, ironically, by high mortality rates in this community. This fear in turn may be why many women avoid screening that enables early detection, which is critical for treatment success.
Many Hmong women believe that they are not at risk for breast cancer, a disease to which the Hmong community has had little exposure, historically. In fact, there is no term the Hmong language for cancer. Few Hmong Americans take preventative steps such as screening for cancer and avoiding cancer causing agents. Health advocates also report widespread misconceptions about medical technology, a fear that the x-ray used in mammogram may cause tumors, for example. As a result, Hmong women avoid seeking medical attention until they experience physical symptoms, which usually occur in later stages of cancer, when it is more difficult to treat.
Breast cancer incidence rates among Hmong women have already begun to increase to the level of other American ethnic groups, which many individuals in the healthcare industry attribute to the mainstream American lifestyle. (6) According to the online medical journal Medical News Today:
"...without education, the Hmong may see their now-low rates of lung, colorectal, breast and prostate cancers begin to climb within a generation... 'if the Hmong follow the pattern seen in other Asian migrant groups, particularly the Japanese and Chinese, their rates of Western cancers like breast and colon cancer will also start to rise. We have a unique opportunity, with the Hmong, to prevent this pattern.' (Richard Yang)" (7)
According to the National Cancer Institute, American Indian women have one of the three lowest incidence rates of breast cancer in the country. (3) Although it is 64% lower than that of Caucasians, the Native American mortality rate is only 9% lower. (2) The Native American community is one of the only ethnic groups which saw an increase in breast cancer incidence between the years 1990 and 1996. (4)
In the past, communication barriers between the medical community and Native American spiritual beliefs have made educational programs challenging. According to Dr. Suzanne Christopher of Messengers for Health, "When we held our focus groups [on the Apsaalooke Reservation in Montana] the women told me, 'if you say the word cancer aloud, you're asking for it to come.'" Messengers for Health aims to provide services which are culturally tailored to their target communities. Christopher stated one example of such adaptations, "We don't use the word cancer. We say health instead." (4)
Breast cancer is the most common form of cancer among Hispanic women, making up 30% of all cancer cases. (5) Unfortunately, in many cases a language barrier limits women's knowledge of breast cancer and the risks it poses to their health. Community resources such as the West Side Community Health Center (WSCHC) help in overcoming these barriers. WSCHC, in cooperation with SAGE, Minnesota's Cancer Screening Project, offers free mammograms for women unable to pay the costs of screening. They also provide transportation and Spanish speaking translators to accompany patients on their visits.
Language barriers are one of several challenges standing between minority women and their health; the issue of modesty is a concern for many women and their families when dealing with breast health. Recognizing this concern, all medical programs permit spouses or other family members to accompany their loved ones to medical exams. Patients may also request female health care providers, or, in the occasion which only a male is available, a female nurse's presence during their exam. Many outreach workers openly discuss modesty with clients in an effort to make women more comfortable and overcome their fears.
The pain associated with receiving a mammogram prevents many women from doing so. Julissa Rios of the West Side Community Health Center stated, "I try to be honest and tell them that it will hurt a little bit, but it will only last about ten seconds and it could save your life."
A lack of financial resources can also prevent women from breast cancer detection. Aside from the high costs of healthcare, financial demands arise from the needs for transportation, treatment and counseling. Programs such as SAGE offer free mammograms to women with or without medical insurance. Minnesota's Cancer Resource Center also provides free transportation to and from clinics for mammograms and treatment sessions.
Early detection is the best way to increase the odds of survival. Among women who have been diagnosed with breast cancer, those who were detected in the fourth stage had a 16% five-year relative survival rate. All forms of cancer are diagnosed in one of four stages. Those who sought medical attention in the first stage of cancer, however, had a 98% chance of survival rate. (8) This means that 98 of every 100 women diagnosed in the first stage of breast cancer lived for five years after diagnosis. (9)
Footnotes:
(1) Stanford Cancer Center
(2) American Cancer Society (.pdf file)
(3) Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute
(5) American Cancer Society (.pdf file)