WORK AND ART BY HAILEY KOPP
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BLACK WOMEN WITH BREAST CANCER
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THE INTERSECTIONALITY OF
TABLE OF CONTENTS
Introduction ..................... 1 Materials and Methods.........3 Findings............................5 Discussion.........................8 Conclusion........................11 References........................12
Introduction
I will be exploring the impact of racial disparities on women suffering from breast cancer, specifically Black women. Understanding the racial disparities within breast cancer is important as breast cancer is the leading cause of cancer death for Black women in the United States. It is essential to deconstruct the systemic barriers that are in place in order to foster awareness that could lead to early detection and more efficient treatment. Oftentimes, Black women are more likely to be diagnosed with advanced-stage cancer, which is more difficult and costly to treat. Therefore, Black women are more likely to be significantly impacted by the economic and social determinants of health that are rooted in systemic racism.
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I am interested in exploring this topic because, as a Black woman, it is important for me to understand the social constructs at play that can impact my personal health and wellbeing, and I am hoping to uncover information that I can use to better serve my community. Also, one of my family members suffered from breast cancer, so I have seen firsthand the mental strength as well as physical strength that is required of women who have received a breast cancer diagnosis. Through this research, I explore how the racialization of breast cancer affects the way in which Black women are diagnosed and treated. I also study how the social burdens and pressures–because of their race and gender– placed on Black women affect the ways in which they seek care and the effectiveness of their treatment.
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Materials and Methods I used a four-step approach for researching intersectionality within breast cancer for Black women: 1. 2. 3. 4.
Identifying a research question Identifying relevant studies Selecting studies Collating the results
Data Sources The following online databases were searched: WebofScience and Proquest. The following search phrases were used to narrow and frame the search: “African American wom*n and breast cancer,” “diagnosing breast cancer in wom*n,” “diagnosing and treating breast cancer in Black wom*n,” “Black wom*n and breast cancer screening,” and “access to breast cancer treatment.”
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Data Selection and Extraction To examine the intersectionality of Black women who suffer from breast cancer, I included peer-reviewed journals and sources that provided statistical data, investigating external factors for risk unrelated to biology in my study. I also included feminist theory literature to offer a critical approach to the scientific research pertaining to Black women with breast cancer. For example, I followed “Black Women with Advanced Cancer and the Challenge of Biomedicine: A Black Feminist Methodological Exploration of the Lived Experience of Terminal Illness,” using frameworks of standpoint theory (understanding group location in hierarchical power relations produces shared challenges and positionality), Black feminist epistemology (centering and understanding lived experiences holistically), and intersectionality [4]. As I examined these sources, I identified various risk factors, exposure, social barriers, and all contributing factors that ultimately determined the diagnosis and treatment of breast cancer for Black women. In order to make sense of these variables, I utilized Krieger’s method of sex/gender diagrams [5].
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Findings Black women have a higher incidence of breast cancer before the age of 40, more severe disease at all ages, and elevated mortality risk compared to white women. In 2012, Black women had a breast cancer mortality rate that was 42% higher than that of their white counterparts [8].
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Figure 1. Differential roles of gender relations and sex-linked and race biology on health outcomes according to various sources, particularly the CDC.
Biological Risk Factors Gender Relations: not a determinant of risk factor Sex-linked/Race Biology: Biological Identification as a Woman From the CDC website: “The main factors that influence your risk include being a woman and getting older” [2]. Reproductive History Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy [2]. Genetic Mutations Black patients with breast cancer that are of African ancestry are more likely to have pathogenic variants in a cancer susceptibility gene than non-Hispanic white patients [3]. Black women are more likely to have subtypes of breast cancer tumors that are more aggressive, more resistant to treatment, and that do not have clear molecular targets for treatment [8].
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Figure 2. Differential roles of gender relations and racialization on health outcomes.
Socioeconomic Risk Factors Gender Relations: lack of a primary care provider, childcare issues, location, transportation [1] Racialization: high levels of stressors in living and working environments for greater duration and intensity, lack of insurance, cost of health care [1,8]
Behavioral Risk Factors Gender Relations: embarrassment from breast exposure during mammograms, perceptions of homophobia, higher prevalence of smoking and alcohol use, low oral contraceptive use [1,6] Racialization: skepticism, mistrust, perceptions of racism, negative experiences within the health care system [1]
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Discussion Biological Risk Factors There is often the belief that there are biological factors, specific to women, that lead to certain outcomes. This perception is perpetuated by the CDC in their description of who is at risk to have breast cancer. In addition to being a woman, the next factor the CDC presents is a woman’s reproductive history [2]. Additionally, genetic mutations seem to be a critical factor that researchers claim to distinguish Black women’s mortality rate compared to non-Hispanic white women’s mortality rate. In a case-control study of 3,946 Black and 25,287 non-Hispanic White women with breast cancer, there was no difference in the prevalence of germline pathogenic variants [3]. Therefore, the linkage of sex, race, and biology is not a well-founded ground to which the leading cause of cancer death for Black women is solely attributed.
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Socioeconomic Risk Factors Mammography screening for breast cancer proves to be an effective method for diagnosing and treating breast cancer, and seems to be the most efficient when conducted in early stages [7]. Black women are impacted by socioeconomic factors that prevent them from obtaining mammography screening. They experience factors such as lack of health insurance, lack of a primary care provider to recommend them screenings, transportation, and lack of childcare support that limit their ability to receive a screening [1]. Due to these factors, Black women are more likely to be diagnosed at a later stage, less likely to receive stage-appropriate treatment, and are more likely to have lower stage-forstage survival rates [8]. Socioeconomic status and racism shape exposure to psychosocial stress, segregation, and physical complications that emanate from the burden of social and environmental disparities. 9
Behavioral Risk Factors Black women are confined by their race and gender that are assigned socially meaningful classifications and ultimately influence their behavior. Black women’s decision to participate in mammography screening is heavily influenced by gender relations and racialization. Some women express embarrassment of exposing their breasts and prefer to conduct selfexamination of the breast as opposed to professional breast examinations [7]. Also, perceptions of race and heterosexism and homophobia cultivate mistrust and skepticism [6]. Black sexual minority women face intersecting issues of racism and homophobia, positioning them for the possibility of greater risk. The behaviors of Black sexual minority women such as nulliparity, lower oral contraceptive use, higher alcohol use, and smoking prevalence contribute to greater risk. They also experience low emotional support and high stress levels during diagnosis and treatment [6]. Their negative experiences within the healthcare system prevent Black women from participating in screening and contribute to their avoidance of healthcare providers 10 altogether.
Conclusion Black women are a diverse group that encompasses an array of socioeconomic strata and cultural beliefs and behaviors. Therefore, investigating the social context of Black women and the course of their breast cancer must be approached with an intersectional framework. Black women’s gendered and racial identity should not become a risk category for breast cancer a priori. Cultural, economic, social and biological factors should be combined to paint a more nuanced picture and understanding of breast cancer diagnosis, treatment, and management.
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References 1. Aleshire, M. E., Adegboyega, A., Escontrías, O. A., Edward, J., & Hatcher, J. (2021). Access to care as a barrier to mammography for black women. Policy, Politics & Nursing Practice, 22(1), 28–40. https://doi.org/10.1177/1527154420965537 2. CDCBreastCancer. (2022, March 9). What are the risk factors for breast cancer? Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/breast/basic_info/risk_ factors.htm 3. Domchek, S. M., Yao, S., Chen, F., Hu, C., Hart, S. N., Goldgar, D. E., Nathanson, K. L., Ambrosone, C. B., Haiman, C. A., Couch, F. J., Polley, E. C., Palmer, J. R., & CARRIERS Consortium. (2021). Comparison of the prevalence of pathogenic variants in cancer susceptibility genes in black women and non-hispanic white women with breast cancer in the united states. JAMA Oncology, 7(7), 1045–1050. https://doi.org/10.1001/jamaoncol.2021.1492 4. James, J. E. (2016). Black Women with Advanced Cancer and the Challenge of Biomedicine: A Black Feminist Methodological Exploration of the Lived Experience of Terminal Illness. ProQuest Dissertations 12 & Theses Global.
5. Krieger, N. (2003). Genders, sexes, and health: What are the connections - And why does it matter? International Journal of Epidemiology, 32: 652—657. 6. Malone, J., Snguon, S., Dean, L. T., Adams, M. A., & Poteat, T. (2019). Breast cancer screening and care among black sexual minority women: A scoping review of the literature from 1990 to 2017. Journal of Women’s Health, 28(12), 1650–1660. https://doi.org/10.1089/jwh.2018.7127 7. Phillips, J. M., Cohen, M. Z., & Tarzian, A. J. (2001). African American women's experiences with breast cancer screening. Journal of Nursing Scholarship, 33(2), 135-40. http://dx.doi.org/10.1111/j.15475069.2001.00135. 8. Williams, D. R., Mohammed, S. A., & Shields, A. E. (2016). Understanding and effectively addressing breast cancer in African American women: Unpacking the social context. Cancer, 122(14), 2138–2149. https://doi.org/10.1002/cncr.29935
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