Social Barriers Affect Prevention Efforts
October is breast cancer awareness month. Breast cancer scares us. It’s the second leading cause of cancer-related death in women, but it feels like there is little we can do to prevent it. Unlike lung and skin cancer, there is no tobacco to quit or sunscreen to slather on.
Yet, research shows that behavioral and socioeconomic factors may play a role in developing and beating breast cancer. Obesity after menopause and high-alcohol intake contribute to an increased risk of developing breast cancer. Race gaps exist in American healthcare: disparate outcomes show that white Americans live longer than black Americans. Poverty, too, plays a role in health outcomes. Are there other socioeconomic factors that might be at play in the case of breast cancer?
According to the American Cancer Society (ACS), deaths caused by breast cancer have fallen since 1989. This decline was largely attributed to a greater focus on early detection and intensive screenings. The ACS has also reported a fall in the incidence of breast cancer. This is all good news, and the ACS recently updated its recommendations for early breast cancer detection, though the change in the ACS guidelines is not without controversy.
Since declining in the early 2000s, the lower breast cancer incidence rate among white women has remained stable, while there has been a slight increase in incidence among African American women. Mammography has undoubtedly saved lives, but there are some women who are still not getting screened as regularly as they should be. A study conducted at urban health centers in Baltimore, MD showed that individual decisions and structural barriers (price, location, and convenience) often prevented the study’s predominately African American women from accessing routine screenings.
Social determinants are important to cancer outcomes. There are barriers associated with poverty and social injustice that contribute to higher mortality rates among impoverished and minority women with breast cancer. One way to begin addressing the disparity in breast cancer incidence and deaths is to remove barriers to preventive screenings and ongoing care. Adequate health insurance, increased access to health centers, and community education and outreach may be good places to start.