Inequities and Social Justice

Facts:

  • African American women are more likely than all other women to die from breast cancer.
  • Latinas are 20 percent more likely to die from breast cancer than Caucasian women diagnosed at a similar age and stage.
  • Low-income breast cancer patients have five-year relative survival rates that are 9 percent lower than higher-income patients.
  • Undocumented immigrants living in the United States are less likely to have access to health care options.

…………………………………………………………………………………………………

There are differences in how specific communities experience and are impacted by breast cancer incidence, mortality and survival. These disparities in breast cancer stem from a complex interplay of economics, power, racism and discrimination that lead to a variety of social injustices, including major inequities in healthcare.

Breast Cancer Action (BCAction) recognizes that a number of diverse communities including young, old, gay, transgender, disabled, immigrants, and under-educated are disproportionately and uniquely impacted by breast cancer. However, due to available data (and lack thereof) on inequities in breast cancer, much of the work in this area is focused primarily on race and class.

Over the last 30 years, the gap in mortality from breast cancer between racial groups has widened.[i] The Center for Disease Control and Prevention (CDC) currently assesses that black women are 40% more likely to die from breast cancer then white women.[ii]  Latina and Samoan women are also more likely to die from breast cancer despite the fact that women in these ethnic communities have a lower incidence of the disease compared to white women.[iii]

Disparities in breast cancer outcomes among different racial and ethnic communities are based on the inequities of a complex interplay of social & economic factors such as where we live, work, learn and play as well as dynamics of power and influence. The important role of social and economic disadvantage such as injustices in opportunity and access to resources as well as structural barriers to receiving high quality healthcare can no longer be ignored.

Conventional solutions to reducing disparities in breast cancer focus heavily on promoting mammography and access to care, and fail to address underlying, persistent social injustices that lead to the differences in outcomes.  Institutionalized hurdles; language and cultural barriers; discrimination related to class, race, citizenship;[xix] a history of exploitation and medical mistreatment creating a legacy of mistrust of the medical community; health literacy; lack of available and appropriate services; and transportation to services, all contribute to the growing disparities in outcomes throughout the breast cancer care continuum.

While creating healthcare access for all increases who gets care, the simple expansion of services without a focus on the quality, delivery and differential care of these services does not eliminate health inequities. Also, moving focus away from an individual’s behavior and lifestyle choices, to issues outside an individual’s control, such as institutional power and discrimination is vital.

BCAction’s work pushes to address and end breast cancer in ways far beyond the simple quick fix approach of increased screening and expanding access to healthcare. Broader solutions to eliminating inequities in breast cancer require policies that improve resources for schools in economically depressed neighborhoods; foster economic revitalization in low-income communities of color; and strengthen environmental protections and enforcement — these are some of the ways to directly impact the root causes of breast cancer inequities. At BCAction, we demand change such as strong regulatory reform to reduce exposures to harmful environmental toxins in all communities and we will always advocate for the necessary systemic changes that will end health inequities.

…………………………………………………………………………………………………………………………………………………………………………………………

For more information, please see our factsheets:

View our webinars on this issue:

 


[i] Menashe, I., Anderson, W.F., Jatoi, I. and Rosenberg, P.S. Underlying Causes of the Black–White Racial Disparity in Breast Cancer Mortality: A Population-Based Analysis. J Natl Cancer Inst. 2009 July 15. 101(14): 993–1000.

[ii] Center for Disease Control and Prevention. Mobidity and Mortality Weekly Report. Vital Signs: Racial Disparities in Breast Cancer Severity — United States, 2005–2009. Vol. 61. No. 45. November 16, 2012.

[iii] Cancer Facts & Figures, 2011-2012. American Cancer Society.

[iv] Haffty BG, Silber A, Matloff E, Chung J, Lannin D. Racial differences in the incidence of BRCA1 and BRCA2 mutations in a cohort of early onset breast cancer patients: African American compared to white women. J Med Genet. 2006;43(2):133–137.

[v] Although for some communities, such as Ashkenazi Jews, hereditary factors may play a larger role in breast cancer risk.

[vi] McGinnis, J.M., Williams-Russo, P. and Knickman, J.R. The Case for More Active Policy Attention To Health Promotion. Health Aff March 2002 vol. 21 no. 2.pp. 78-93.

[vii] Robert Wood Johnson Foundation. Overcoming Obstacles to Health. Commission to Build a Healthier America. 2008.

[viii] Adler, NE and Rehkopf, DH. U.S. Disparities in Health: Descriptions, Causes, and Mechanisms. Annu.Rev. Public Health. (2008) Vol. 29: 235-252.

[ix] Robert Wood Johnson Foundation. Overcoming Obstacles to Health. Commission to Build a Healthier America. 2008.

[x] Institute of Medicine. 2012. Breast cancer and the environment: A life course approach. Washington, DC: The National Academies Press.

[xi] Brody, J.G., Kavanaugh-Lynch, M.H.E., Olopade, O.I., Shinagawa, S.M., Steingraber, S. and Williams, D.R. Identifying gaps in breast cancer research: Addressing disparities and the roles of the physical and social environment. California Breast Cancer Research Program Special Research Initiatives. Aug 2007

[xii] Reynolds P, Hurley S, Goldberg DE, Anton-Culver H, Bernstein L, Deapen D, Horn-Ross PL, Peel D, Pinder R, Ross RK, West D, Wright WE, Ziogas A. Regional Variations in Breast Cancer Among California Teachers. Epidemiology. 2004, 15(6):746-54.

[xiii] Bullard, R.D., Mohai, P., Saha, R. and Wright, B. Toxic Waste and Race at Twenty: 1987-2007: Grassroots Struggles to Dismantle Environmental Racism in the United States. Cleveland, OH, USA. United Church of Christ, Justice and Witness Ministries. 2007. Available at http://www.ejnet.org/ej/twart.pdf

[xiv] Alameda County Public Health Department. Life and Death From Unnatural Causes: Health and Social Inequity in Alameda County. April 2008. Accessed at http://www.barhii.org/press/download/unnatural_causes_report.pdf on January 20th, 2012.

[xv] Lurie, N. and Dubowitz, T. Health Disparities and Access to Health. JAMA. Mar 2007. Vol.297. No.10. pgs. 1118-1121

[xvi] Brody, J.G., Kavanaugh-Lynch, M.H.E., Olopade, O.I., Shinagawa, S.M., Steingraber, S. and Williams, D.R. Identifying gaps in breast cancer research: Addressing disparities and the roles of the physical and social environment. California Breast Cancer Research Program Special Research Initiatives. Aug 2007

[xvii] Brody, J.G., Tickner, J. and Rudel, R.A.Community-Initiated Breast Cancer and Environment Studies and the Precautionary Principle. Environ Health Perspect. 2005 August; 113(8): 920–925.

[xviii] Brody, J.G., Kavanaugh-Lynch, M.H.E., Olopade, O.I., Shinagawa, S.M., Steingraber, S. and Williams, D.R. Identifying gaps in breast cancer research: Addressing disparities and the roles of the physical and social environment. California Breast Cancer Research Program Special Research Initiatives. Aug 2007

[xix] Quach, T. Nuru-Jeter, A. Morris, P. Allen, L. Shema, S.J. Winters, J.K. Le, G.M. and Gomez, S.L.  Experiences and Perceptions of Medical Discrimination Among a Multiethnic Sample of Breast Cancer Patients in the Greater San Francisco Bay Area, California. American Journal of Public Health: May 2012, Vol. 102, No. 5, pp. 1027-1034.

[xx] Kalager,M., Adami, H., Bretthauer, M., Tamimi, R.M. Overdiagnosis of Invasive Breast ssCancer Due to Mammography Screening: Results From the Norwegian Screening Program. Annals of Internal Medicine. 2012 Apr. 156(7):491-499.

[xxi] Brawley, O. ‘Overdiagnosis’ of breast cancer may be higher than thought. CNN Health. CNN.com Apr 2nd, 2012. Accessed December 4th, 2012: http://www.cnn.com/2012/04/02/health/brawley-overdiagnosis-breast-cancer/index.html

[xxii] Brawley, O. ‘Overdiagnosis’ of breast cancer may be higher than thought. CNN Health. CNN.com Apr 2nd, 2012. Accessed December 4th, 2012: http://www.cnn.com/2012/04/02/health/brawley-overdiagnosis-breast-cancer/index.html

[xxiii] Lurie, N. and Dubowitz, T. Health Disparities and Access to Health.  JAMA. Mar 2007. Vol.297. No.10. pgs. 1118-1121