October is synonymous with breast cancer in the Caribbean. The 16th annual “Walk for the Cure” was held on 7th October 2018 in Barbados. In Jamaica, its cancer society hosted a number of similar activities in October, in an attempt to bring more awareness to the disease.
According to the American Cancer Society (ACA), breast cancer begins when the cells within the breast grow out of control, and produce or form tumors that are either felt physically as a lump, or noticed under an x-ray. It is mainly found in women.
Outside the medical realm, little is known about breast cancer, although it is one of the leading causes of cancer deaths among Caribbean women according to the Jamaica Gleaner.
Research within the Caribbean
Up to two decades ago, breast cancer was not on the region’s public health agenda. Since then, more information on the disease has been shared through marketing campaigns, and news bulletins to alert women and to encourage screening. Regrettably, information is not prevalent year round.
Much of our understanding and knowledge about the causes, impacts and treatment of breast cancer relies heavily on research from the United States and Europe. While useful, it does not fully address the Caribbean cultural context. This is key to understanding the Caribbean woman’s response to her diagnosis.
The woman and her identity in the Caribbean
Traditionally, a woman’s role is one of being the primary caretaker of the family. Girls are taught how to care for families, nurturing her role as one of bearing children and child-rearing. Furthermore, we entrust the initial source of nourishment for a child through a woman’s biological make-up when we think of the natural technique of breastfeeding. As such, gender roles are defined.
Our culture has portrayed Caribbean women as objects by their male counterparts. This is displayed through our music, dance and revelry; with the popular genre, dancehall. This preponderance of society’s objectification leads to implications for Caribbean women and their relationship with their breasts.
For society and for a woman, the breast is one of the main external signs of femininity. The loss of such an important organ can have physical, emotional and psychological impacts on a woman.
Physical impact on the woman
A breast cancer diagnosis is a very distressing and unpleasant experience, affecting a woman’s quality of life in many different ways.
On the onset of this diagnosis, a woman may notice a change in colour or size of her breast. With treatment, these physical changes could manifest in long-term effects of body transformations (e.g. fatigue, pain and nausea); impacting the way a woman feels about herself.
Changes in appetite and feeling unwell are other symptoms associated with breast cancer, impacting a woman’s ability to function. This results in the collapse of the Caribbean family unit, as the woman – the primary caretaker, breadwinner and nurturer of the family – is unable to function.
Breast cancer treatments can also affect a woman’s reproductive organs, which could lead to infertility. Infertility can have a significant impact on a Caribbean woman, who is socially defined by her ability to bear children and her nurturing nature.
Whether these physical changes are temporary or permanent, they begin to affect a woman emotionally. Feeling self-conscious and less confident about what she can do, she begins to have fears and worries. These fears can lead to the emergence of psychiatric disorders such as anxiety and depression.
Emotions such as increased stress, anxiety and uncertainty about the future are also common, partly due to such factors as prolonged treatment and side effects from medication (chemotherapy). These emotional issues typically extend after the initial shock of diagnosis has passed and treatment has occurred.
There is a link between physical and psychological health, especially as it relates to breast cancer in women. In addition to the personal battle in coping with a cancer diagnosis, women may face external psychological challenges such as discrimination from employers due to absences from work; and from insurance companies, where receiving claims becomes more difficult.
Culturally, the breast also plays an enormous maternal and sexual significance. The loss of such a vital organ may cause a woman to develop unhealthy addictions such as using alcohol, cigarettes or caffeine to soothe herself.
Psychological challenges, cultural regard and daily obstacles can lead to feelings of unattractiveness, loss of feminine identity and lower self-esteem. This can lead to psychiatric disorders, with any disorder being very debilitating, affecting a woman’s physical daily performance, thoughts and quality of life.
Mental health professionals in the Caribbean can assist women with a breast cancer diagnosis by helping them adjust and cope with the physical, emotional and lifestyle changes associated with the disease. However, one type of treatment cannot be applied universally. For one woman, the focus may be on how to explain her illness to her children or significant other. Another woman’s focus may be on finding the best medical care.
Psychologists aid women in helping them work through their emotions through therapy. Emotional recovery may take longer than physical recovery and societal pressures to “get back to normal” may be intense. Breast cancer survivors need the time to create a new self-image that incorporates the new changes to a woman’s body and their emotional and psychological journey.
A need for more Caribbean-oriented research
There is a need to counteract the paucity of knowledge and literature in the Caribbean, specifically as it relates to our women and the immense impact a diagnosis of breast cancer can cause.
Much is known about the multiple impacts of breast cancer on women through the ACA. However, to better understand the impacts on our Caribbean women, the development of research at each national level will need to be undertaken. This culturally sensitive research will enable our mothers, sisters, daughters and friends to see the importance for early screening and detection and offer medical and psychological treatment adapted to their cultural and personal needs.