Posted on December 17, 2021

By Dr. Krystal Redman, DrPh, MHA (They/she)

BCAction’s response: Addressing COVID-19 and Breast Cancer in Black Communities Requires Trust Building

In one of the opening sessions of the San Antonio Breast Cancer Symposium (SABCS), COVID-19 and Cancer, patient advocates, on behalf of the entire community of people living with breast cancer, stressed the critical need for everyone to get the COVID vaccine. Not only does this protect us all, it’s particularly important for the immunocompromised, including people who have been diagnosed with both COVID and breast cancer. The term “fully vaccinated against COVID” is being gradually redefined to mean that you have received the third (booster) dose, and the importance of wearing masks when indoors continues to be stressed. 

Most people have never navigated a pandemic of this magnitude, hence the fear and uneasiness that we have come to be so familiar with over the last two years. Imagine, however, if you had to navigate not just COVID, but also breast cancer. While experts continue to stress the importance of routine breast examinations and breast self-examination for all genders, some people receiving treatment for breast cancer worry about going into cancer treatment centers or for oncologist visits. Others wonder if they need to stop their breast cancer treatment altogether. So, while the pandemic has been an exerting time for everyone, it has been a double whammy for people living with breast cancer.

Despite the challenges and uncertainties of this time, some folx are still willing to brave the chaos and get the help they need, only to be faced with formidable barriers to care. Previously existing barriers have been heightened in the wake of COVID, and new ones rear their faces. Plagued by historic levels of job loss, housing instability, and a need to balance homeschooling with being a caretaker, among other challenges, focusing on complying with treatment has become near-impossible for many. Giving attention to treatment, even for a life-threatening condition like breast cancer, becomes challenging if it means making a choice between getting treatment and putting food on the table, for example. Truth be told, only time will tell what the true impact of COVID has been on the health outcomes of people with breast cancer. 

Trust was a common theme and weaved throughout many topics at this year’s symposium. As if these obstacles were not enough, people in the Black and Afro-Indigenous community also have to wrestle with distrust in medicine, public health, and science as a whole. Their distrust is for good reason too. By now, most people, even those who are not Black and Indigenous People of Color (BIPOC), are well aware of such injustices as the Tuskegee Study, the Manhattan Project, or Henrietta Lacks and her HeLa cell lines, to mention but a few. Built on a foundation of historical, systematic harm done by the scientific community to BIPOC folx, and perpetuated in our day by medical practices and health policies that deepen health disparities, there is a tangible fear of the COVID vaccines in communities of color. People are asking the scientific community, on the one hand, and the systems of government, on the other, “why should we trust you?” And the answer to that question is not in a description of how so many people are dying from the virus – after all, people of color have been dying for hundreds of years, and they continue to die today, at the hands of science – but is rather in acknowledging the disparities that exist, and have cost countless Black and Indigenous People of Color their lives.

Even now, in the context of the COVID-19 pandemic, as people of color continue to face disparities in their struggles to live in a rapidly changing world, universal health care is being actively discussed. Having universal health care helps, but it does not solve all problems. How would universal healthcare answer the question of unemployment, lack of benefits, unstable housing, poor living conditions, and numerous other societal ills? The economic devastation caused by COVID to people of color and BIPOC communities might take them generations to recover from, given the baseline of pre-existing inequities, even prior to COVID. What’s more? The exacerbation of health and socioeconomic disparities by the pandemic further increases the risk for breast cancer disproportionately among these communities as BIPOC folx begin to fall deeper within the margins thus resulting in further health inequities. 

It is certainly not too late to address the impact of COVID and breast cancer in communities of color; however, doing so would require bold, deliberate action, and brazen intentionality. Restitution and reconciliation cannot be thorough without an acknowledgement of injustice. An effective intervention would demand building trust and being painfully honest about the historical and current mistreatment of Black people by the healthcare and scientific community as a whole. We cannot just “move past the past.” Simply ignoring the problem or pretending that it does not exist will not make it go away. Black people and other people of color must be offered the support they need at this time, to develop sufficient trust, on their own terms, enough to feel comfortable with getting vaccinated, in order to protect themselves, their families, and the immunocompromised.