Do a Google search for “breast cancer risk” and you’ll find a lot of information about obesity, diet, alcohol, and genes. What you won’t find – very easily, at least – is information connecting where we live, work and play, and how society treats us as people, to who gets breast cancer, at what age, and how likely they are to die from it.
Race and class inequities in breast cancer outcomes are not solely the fault of low screening rates, limited access to healthcare, or individual “lifestyle choices” – though that’s what the mainstream narrative would have you believe. The elephant in the room is the reality that inequities in breast cancer incidence, mortality and survival stem from a complex interplay of social and economic factors, including power dynamics, race/ethnicity, and discrimination. Yet to read the news, or mainstream breast cancer websites, you’d think there’s a magical eat-right-exercise-maintain-a-healthy-weight silver bullet to resolve the grossly unequal health outcomes between white and non-white, poor and rich.
We cannot continue to let the dominant narrative about breast cancer – and our health in general – leave out or footnote important social and economic factors that have a very real impact on our health. Here are some recent examples of how these factors play a role in the breast cancer epidemic:
At the end of last year, the Center for Disease Control and Prevention (CDC) released a report analyzing breast cancer incidence and mortality data from 2005-2009. They found that although breast cancer death rates for women in the U.S. are declining, not all communities are benefiting. African-American women now have a 41% higher breast cancer death rate than white women, which has been rising since the 1980s. While the CDC attributed this difference to lower rates of screening and less access to care, it also stated that there is “a substantial part of these differences [that] remains unexplained.” So it seems that factors such as racism and discrimination, language and cultural barriers, “fenceline communities” (poorer neighborhoods, predominately communities of color, located immediately adjacent to industrial facilities) and occupational hazards fall into the “unexplained” category.
Earlier this year, the December 2012 edition of the Journal of Cancer Survivorship, published an article on “Racial and ethnic differences in health status and health behavior among breast cancer survivors—Behavioral Risk Factor Surveillance System, 2009.” According to this study examining racial and ethnic differences among breast cancer survivors, researchers concluded, yet again, that surviving breast cancer comes down to what you do as an individual, and that interventions promoting healthy lifestyles are key. This article, however, failed to mention the social context in which women make choices about their behavior. We know that different communities have different social advantages or disadvantages that determine the options they have to make healthy choices. As long as we continue to tell people to make better choices without increasing access to resources, we continue to set women up for perpetual failure and we continue to blame them for their disease.
The Atlantic recently published a very interesting article by Jason Silverstein about how racism affects our health. “How Racism Is Bad for Our Bodies” focused on stop-and-frisk policies and the impact racism and discrimination – and even anticipated racism and discrimination – has on the health of people of color. The article notes that discrimination has been shown to increase the risk of stress, depression, the common cold, hypertension, cardiovascular disease, breast cancer, and mortality. Social epidemiologist Nancy Krieger, one of the field’s leaders, terms negative health outcomes as a result of discrimination “embodied inequality.”
Silverstein writes: “Racism works in a cycle to damage health. People at a social disadvantage are more likely to experience stress from racism. And they are less likely to have the resources to extinguish this stress, because they are at a social disadvantage.” So we begin to see how our individual choices are not apolitical, and do not occur in a vacuum. As the article points out, this “embodied inequality” can be generational: “These are ways that discrimination becomes embodied during one person’s life. But no person discriminated against is an island. When conditions of social injustice affect this many people, and prompt poor health outcomes, risk passes down generations. And this damage isn’t going away any time soon. Even in the absence of discrimination, Nancy Krieger argues, populations “continue to exhibit persistent disparities reflecting prior inequities.”
If we really want to address inequities in breast cancer and end the epidemic, we need to make room in our breast cancer narratives for the inextricable link between social and economic factors to our health, factors such as race, power and neighborhood resources, as well as the structural barriers that prevent too many communities from receiving high quality healthcare.
Breast Cancer Action continues to challenge our society’s strong and over-simplified emphasis on personal behavior as the silver bullet. We believe that effective strategies to eliminate inequities and reduce disparities in breast cancer incidence, mortality and survival, require a broader focus on the social and economic contexts in which we all live. Until the dominant narrative changes, we’ll keep working to change this conversation about breast cancer as we have so many others.
To learn more about how social and economic factors influence breast cancer inequities, check out our webinars on inequities.