Beyond the ACA: Barriers to Breast Cancer Care Remain
"Race and place" continue to play an integral role in foiling women's (and men's) fight against breast cancer, with women of color being diagnosed younger, and surviving less, said Breast Cancer Action's education and mobilization coordinator, Sahru Keiser.
"It is not just genes but social inequalities that lead to disparities in breast cancer incidence and outcome,” she said, “Women of color have more aggressive breast cancer at younger ages with lower survival rates.”
Even in places with universal health care – a goal the United States is attempting to reach with the implementation of the Affordable Care Act – racial disparities in quality of care are still pronounced.
The webinar “Reducing Inequities in Breast Cancer: Why Experience Matters” followed up on an earlier webinar by Breast Cancer Action, highlighted barriers that remain for marginalized women, even when theoretical legal barriers preventing access to health care have been removed.
Of the 450 patients treated at the Shanti Project’s Breast Cancer Program, 85 percent live below 200 percent of the poverty line, and 70 percent are unemployed during or immediately after treatment. These women live on an average of $200 a month after rent, and the program's director, Maria Caprio, noted that “paralyzing anxiety” about personal finances can interfere with following up with treatments and making appointments.
Genetic counseling and testing for BRCA mutations - which give a patient an 80 percent lifetime chance of developing breast cancer - have become the standard of care and although people of color make up approximately 35 percent of the nation's population, less than 13% of those who receive the genetic BRCA testing.
Genetic testing has revolutionized breast cancer care – but, Galen Joseph, an Assistant Professor in the Department of Anthropology, History, and Social Medicine and the Helen Diller Family Comprehensive Cancer Center at University of California at San Francisco said “[these] advances in genetic medicine can exacerbate breast cancer disparities if low-income women are unable to access and benefit from genetic risk services.”
A history of racial residential segregation and a public housing crisis are key contributing factors to accessibility. “Where you live will determine what kind of health care services you have access to, regardless to whether you have health insurance,” Keiser said. “There’s a real need to address housing as a way to address health.”
“A history of [women of color] feeling that the medical system may not treat them with respect and dignity” strongly informs tense relationships between women of color and their health care providers, said Keiser. But it’s about more than flawed individual relationships – “it’s really about the collective failure of an organization to provide appropriate care.”
Though the Affordable Care Act reflects significant progress towards removing legal barriers, these barriers still remain, especially for undocumented youth and young people of color. Given recent policy announcements from the Obama administration which deny coverage under the ACA to DREAM-eligible youth, these barriers remain substantial.
And for young women as a whole, lack of knowledge and awareness that people in their age group regularly develop breast cancer represents a barrier to appropriate testing and screening. The Huffington Post recently reported that of the 250,000 people diagnosed with breast cancer every year, 11,00 are under the age of 40, and young women are more likely to develop more aggressive forms of breast cancer and face higher mortality rates. For youth, people of color, the undocumented, and those living in poverty, scientific advancements and legal victories have not done enough to ensure quality care. Dismantling remaining barriers is crucial to providing adequate support for those living with breast cancer in America.
Pauline Holdsworth is a reporter for Campus Progress. Follow her on Twitter at @holdswo.