Breast Health Equity and Why it Matters
Considering Breast Health Equity for Racial Minorities, Males, and LGBTQIA+ Community
Written by: Alex Payton, she is an undergraduate student at UNCW and a Public Health intern at Going Beyond the Pink.
In the United States, breast cancer is one of the most common forms of cancer found in women. As of today, there is a 1 in 8 chance a woman will be diagnosed within her lifetime and this risk increases with age. The increase of medical technology, effective treatments, and early detection screenings have decreased mortality rates of this disease overall. Although these excellent improvements are effective for our breast cancer community, it’s important to note that unfortunately not every population is included. This is due to the various health disparities seen within diverse populations which directly impacts their breast cancer incidence and mortality rates.
Breast Health in Racial Minorities
When comparing breast cancer rates before age 45 between Black and white women, the rate is higher among Black women. What is even more alarming is that Black women are more likely to die of breast cancer at every age. It is no surprise that these rates are due to historical racial inequalities seen in healthcare that continue to adversely impact mortality rates for Black women in comparison to their ethnic counterparts. In addition to healthcare barriers that prolong the wait of treatment for Black women, there are additional limitations such as inequalities in housing, socioeconomic status, barriers to accessing cancer prevention and treatment, and other wealth inequalities known as social determinants of health.
Breast cancer prevention and early screenings are important for risk reduction. However, we have to recognize why access to early screenings, treatments, and supportive services may not be ideal for patients of color due to specific structural barriers and discrimination. Because of this, patients of color are also less likely to receive needed treatment and resources in comparison to white patients.
How can we address breast health inequity?
We hear time and time again that prevention and early, frequent screenings are suggested to help reduce the risk of a breast cancer diagnosis for Black women and racial minorities. However, we know that this approach is inequitable if we don’t also acknowledge why these options aren’t always feasible for racial minorities. These methods are most definitely helpful in reducing incidence and mortality rates, but advocating for accessible, affordable, and adequate health care services and resources to promote optimal well-being for racial minorities whether with or without a breast cancer diagnosis continues to be necessary.
Some ways to start is by getting communities to work together to identify and understand gaps in access to care for minority populations within the community. From there, we can better understand these populations’ needs and implement evidence based interventions to foster just and equitable care. Going Beyond the Pink is proud to be an example of this work in our local community through our collaboration with the American Cancer Society and Novant Health which addresses breast health equity locally in the Southeastern NC region. These collaborative efforts have led to social determinants of health screenings during the appointment process for mammograms to better understand any additional unmet needs, increased usage of mobile mammography, funding to overcome transportation barriers to appointments, and community peer training to support minority communities from within with knowledge and resources needed to ensure more Black and Latina women have access to the screenings they need.
How can you reduce your risk?
Here are some guided healthcare tips for those with a family history of breast cancer or those who may be showing signs/symptoms:
It is suggested that African American women begin mammograms or ultrasounds earlier before age 40
Women ages 40 to 44 should consider getting annual mammograms
Women 45 to 54 should get annual mammograms
Get comfortable with breast self awareness. Learn what your breasts usually look and feel like so you will notice changes. If you find unexplained changes, share that with your doctor
Know your family health history and communicate with your doctor about the screenings that are right for your unique needs
Resources specific for racial minority breast cancer needs
For further readings and resources:
To learn more about breast cancer disparities for Black women and racial minorities, check out our blog here: The Diverse Experience of Breast Cancer. Also check out this podcast and more from the National Patient Advocate Foundation called “Dying to Be Heard” which shares the story of Adrienne Moore, a Black woman and two-time cancer survivor, who experienced a delayed cancer diagnosis and other health inequities prompting her to advocate for other Black women whose voices are often left unheard.
Male Breast Health
Can men get breast cancer?
Yes! The American Cancer Society tells us that about 2,710 new cases of invasive breast cancer will be diagnosed in men and about 530 will die from this disease. Although male breast cancer is less common, 100 times less common for white men and 70 times less common for Black men, it’s not just a “woman’s disease.” The lifetime risk of male breast cancer is about 1 in 833 men, accounting for about 1% of breast cancer diagnosis. From this small percent, men are not as likely to do early screenings and more likely to be under-treated putting them at risk for high mortality rates.
And like Black women, Black male breast cancer patients are more likely to have a worse health outcome in comparison to their white male counterparts. Because male breast cancer is not as prevalent, more research is needed especially the aspects of cancer care. There also aren’t many resources available specifically targeting this group. The stigma around breast cancer being a “woman’s disease” creates an additional barrier and can make breast cancer feel like an isolating experience.
The female focus around breast cancer research creates the stereotypes that breast cancer is connected with femaleness. Additionally to having to cope with the disease, male patients may struggle with the gender aspects of suffering from a perceived women’s illness, feminization in therapy, and emasculation in studies of male breast cancer patients. Breast cancer is more rare in men than women, but it does happen to men. Addressing the feminine stigma is one way to reduce barriers to equitable care for men with breast cancer.
Research is showing that the death rates for men are higher than women across all stages of breast cancer. This is due to minimal guidelines for male breast cancer screening or reminders for them to conduct self breast checks. More is needed to raise awareness that men can get breast cancer. Advocacy is also needed to support male breast cancer patients and survivors. Screenings and treatments are definitely effective and helpful in reducing their mortality rates, but male breast cancer patients and survivors also need additional supportive services such as follow up care, educational resources, financial support, etc.
How is male breast cancer possible?
Now that we know breast cancer is not a woman’s disease, let’s talk about how it’s possible for men to have breast cancer. Breast cancers can start from various places in the breast, but most commonly begin in the ducts. Others can begin as lobular cancer inside of milk production glands, but these cases are extremely rare.
Commons signs of male breast cancer
Possible signs and symptoms of breast cancer in men include:
A lump or swelling
Skin dimpling
Inward nipples
Redness or scaling of the nipple or breast skin
Nipple discharge
What you need to know to reduce your risk
Risk reduction starts with knowledge, so having a detailed family history of any genetic mutations known to impact your breast cancer risk, and sharing this information with your primary care physician is the first step. Next it is important to know how to do self breast checks and perform them regularly once you know your risk.
Let’s do our part to reduce the stigma of male breast cancer and raise awareness!
Resources specific for male breast cancer needs
For further readings and resources:
To learn more about male breast cancer, check out our blogs here: What You Need to Know About Male Breast Cancer and Signs & Symptoms of Male Breast Cancer
LGBTQIA+ Breast Health
The LGBTQIA+ community also face inequities which puts them at a higher risk having less access to preventative care, accurate and timely diagnosis, and time-to-treatment delays resulting in unjust disparities in their survival rates. There is very little research reporting the incidence of breast cancer within the LGBTQIA+ community a lot of times due to studies that are small and of poor quality. National registries and databases also don’t have inclusive sexual orientation data which can mean we don’t have clear and precise data to understand the impact of breast cancer in these communities.
Research is continuing to show that there are lower rates of mammograms, colonoscopies, and pap smears in comparison to their heterosexual counterparts. In addition to inadequate access to healthcare services and resources, lower rates of health insurance coverage is another structural barrier that limits the LGBTQIA+ community because many insurance companies don’t offer policies to unmarried couples. Given the historical and political context and climate around marriage laws in the U.S. for LGBTQIA+ couples, some are not able to access health insurance.
A cancer diagnosis is already frightening enough on its own, but these fears and anxiety only heighten when you’re part of an historically marginalized group. We have to continue raising awareness and advocating for equitable health care for the LGBTQIA+ community.
Resources specific to LGBTQIA+ needs
For further readings and resources:
To learn more about LGBTQIA+ barriers and disparities in cancer care, check out our blog here: LGBTQ+ Barriers to Care
Why does breast health equity matter?
After reading all of this information about how a breast cancer diagnosis affects our diverse populations differently, you may still be wondering why does any of this matter or how does this apply to me? Having these conversations and learning about complex, uncomfortable topics are important so that all of us can have a better understanding of how these groups are affected by breast cancer, their unique needs for care and resources, and ways we can center their voices when raising awareness about breast cancer. This is one of the first steps of many to address breast health equity and it’s essential that we continue to learn and advocate for these communities.