by Brenda Salgado, Program Manager
For numerous illnesses, serious health inequities exist between different racial and economic groups, and breast cancer is no exception. African American women with breast cancer die at a higher rate than any other racial group, and studies reveal that African American and Latina women diagnosed with breast cancer are less likely to receive standard of care treatment. Low-income women are less likely to have employer-sponsored health care, placing them at great financial risk if they are diagnosed with breast cancer.
Of course, these inequities occur in the larger context of our social and political environments. For example, people who live close to a hazardous waste site are at increased risk for breast cancer, even after adjusting for known risk factors. They are also more likely to die of breast cancer. Historically, toxic sites have been situated predominately in communities of color and low income communities, which then bear a disproportionate burden of exposure to harmful chemicals.
In the social justice and public health fields, discussions about eliminating health disparities have already begun to focus on addressing the root causes in our social and physical environments. Low-income children of color have much higher asthma rates. Alongside efforts to provide asthma education and medical care, many public health officials recognize that poorly built housing, diesel truck traffic, and poor air quality in and near schools are significant contributors to this health inequity.
In the breast cancer world, though, research on disparities has focused primarily on two areas: genetics and personal behavior. Studies have examined the prevalence of BRCA gene mutations and differences in screening rates, obesity, and diet of breast cancer patients of different races. While these point to pieces of the puzzle, they tend to focus on an individual woman’s inheritance of “faulty” genes or her responsibility for having “caused” her disease.
BCA challenges this conventional approach to addressing breast cancer disparities. Eliminating differences in breast cancer incidence and outcomes requires us to look deeply and honestly at how issues of race, economic status, and political power—things outside an individual’s control—affect who enjoys good health and who does not, and whether or not communities are engaged in the decision-making processes that will ultimately affect their resources and overall health.
We must push researchers and the broader breast cancer movement to take this larger view with us. We have much work to do to achieve this.
For example, a study in May 2008 focused on teenage girls, showing that regular physical activity may reduce their risk for breast cancer later in life. A resulting news article admonished readers to “get your daughters off the couch.” Similarly, studies have shown an increased risk for breast cancer in postmenopausal women who are overweight.
What is missing in these reports is the larger context: the choices we make are shaped by the choices that are available to us. A healthy diet and regular exercise are important for all of us, but they are about more than self-discipline.
Some neighborhoods have easy access to healthy and organic foods; others have only fast food restaurants and liquor stores nearby. Some communities have safe streets and green environments in which to run and play, while others are unsafe to walk even during the daytime. Some have safe housing with minimal exposure to environmental contaminants, while others are near toxic release sites or live in communities built with cancer-causing materials.
Like the hazardous waste facilities, these neighborhood differences follow a pattern. They respect communities with differences in race and income. If we truly seek to reduce inequities in breast cancer, we must act to address their root causes. As we advocate for all breast cancer patients to receive the best care available, we must simultaneously urge solutions for the injustices that keep so many communities unhealthy in the first place. As a society we must recognize that improving social and economic conditions is a decision to afford everyone equal access to prosperity and good health.
As BCA continues to take these conversations from the personal to the political, we will push for researchers and the cancer community to widen their lens and understand that a world divided by social inequities poses great ethical challenges for improving health, and that a strict focus on genetics and personal behavior is simply not enough.
BCA has changed many conversations in breast cancer, and we will work to change this one as well so that people will see breast cancer through a social justice lens in order to eliminate the inequities in breast cancer. We must work to create policies that will ultimately make healthier lives an option for all of us.
In the words of Elenore Pred, “Together, we have the power to change things.” Please join us on this journey to change the conversation about differences in breast cancer incidence and mortality.