While breast cancer poses a threat to all women, the outcomes are more severe for some. According to the American Cancer Society, Black women have the highest breast cancer death rate among all racial groups, being 40% more likely to die from breast cancer than white women, despite sharing similar incidence rates. Additionally, Black women are more likely to be diagnosed with breast cancer at a more advanced stage or at a younger age, and are less likely to survive breast cancer five years after diagnosis.
Though public health experts are still trying to understand the reasons for these disparities, research suggests a variety of socioeconomic factors, including lack of access to quality preventative care and treatment, limited education on breast health, and structural racism within medicine itself, may be contributing to the disproportionally higher mortality rate among Black women. Historically, African Americans have also reported lower levels of trust in healthcare providers, due to experiences involving fear of discrimination.
In light of this, we spoke with One Medical provider, Shannon Brantley, RN about her family’s personal experience with the fight against breast cancer, the gap in breast health and other helpful information about breast cancer screening. Brantley, who is African American herself, lost her mom to breast cancer at the age of 16.
Q: What was your experience seeing your family members get breast cancer? How does it make you feel about your future health?
A: My mom was diagnosed with inflammatory breast cancer (IBC) at the age of 45. Her illness course was very quick — she passed away less than three months after she was diagnosed. I was 16 years old at the time and it was a very traumatic and formative experience in my life to say the least. A few years after my mother’s death, my mother’s sister was diagnosed with breast cancer at the age of 49, went through treatment and has been cancer-free since.
I would consider my mother to have been a relatively healthy person. She was proactive in her health by visiting her doctor annually and getting routine screenings but because of her age, and the fact that our family did not have a strong cancer history prior to her diagnosis, she was considered to be low risk for breast cancer. Her specific diagnosis of IBC is a rare form of breast cancer and unfortunately it was not detected early by a routine screening mammogram until it had progressed.
My mother’s diagnosis as well as my aunt’s diagnosis have definitely affected how I feel about my health. Their experiences made me much more aware of how I need to start breast cancer screenings at an earlier age. I’ve done genetic testing for the BRCA gene (I’m negative), and I’ve also done my own research about the different breast cancer screening options and plan to have a discussion with my primary care provider (PCP) about which method may be better when I’m due to start screenings.
Q: How does your family perceive their risk for breast cancer?
A: The women in my family definitely perceive our risk for breast cancer to be higher than average mainly due to my mom’s and aunt’s experiences (both were under the age of 50 years old when they were diagnosed). Other than family history, we are all aware of the disparities in how breast cancer affects African-American women. I think this has helped us be more proactive in our health and advocate for ourselves in regards to having open discussions with our PCPs regarding our individualized risks and how we should be screened for breast cancer.
Q: What are some of the barriers you and your family have experienced in getting screened for breast cancer?
A: My aunt, who is a breast cancer survivor, has spoken with me about her having to push to get MRI breast cancer screenings in addition to mammography. Despite her own personal history of breast cancer, she still has to advocate for more advanced screening methods than what is routinely recommended.
I’ve personally experienced push-back about being screened for breast cancer due to my age. A few years ago, I needed to get a mammogram and ultrasound after I noticed an abnormal mark on my breast. When I called to schedule the appointment for testing, the radiology center was hesitant to schedule the mammogram due to my age (I was 27 years old) and concern for radiation exposure. I remember the person I spoke with specifically saying “Why do you even need this? You’re so young.” I felt very judged and insecure following through with getting the procedure done but I also recognized the importance of following up on the abnormality I noticed on my breast.
I think these types of barriers that require the patient to advocate for themselves against what’s routinely recommended create an antagonistic relationship between the patient and provider or healthcare system. I think that if a patient is made to feel as if they are not an expert of their own health needs, it can create great mistrust in the healthcare system and affect how a patient may follow up on their concerns in the future.
Q: How do you feel your family’s experience with breast cancer informed your approach to patient care, specifically with patients of color?
A: I think it’s important to just take the time to listen to patients. In healthcare, we want to teach our patients, give them all the information, and tell them what is needed. But a lot of times, and I saw my family go through it firsthand, it feels like you’re not being heard by your doctors.
My family’s personal experience was a huge motivator for me wanting to become a nurse. After my mom’s death, I felt like no one cared about me. I just didn’t feel very important. Now, as a nurse, I try to take the time to listen to my patients after I've spewed a bunch of information at them, and ask, “What questions do you have? How do you feel about everything we just discussed?” and listen to their concerns.
One thing I always tell patients is, make sure all of your questions get answered. If you have to write them down and go through them one by one with your provider, do it and take your time. We really do want to discuss all of your concerns with you and help you accomplish your health goals. I make sure to allow time for patients to really talk and express themselves.
I also think for people of color, it’s nice to see someone who looks like you taking care of you. I think that seeing a provider that looks like you can provide patients with a sense of relief that the provider will have a shared sense of understanding and hear them. I try to relay to patients that, I am listening, I am hearing you, and I do want to help you. I try to give them that sort of comfort. When you look at the history of healthcare, there are a lot of reasons why patients of color may not trust healthcare systems. So I try to be a person in healthcare they can trust.
Q: What advice do you have for African American women about breast cancer screening?
A: Be proactive and be an advocate for yourself. I think it’s very important to have a primary care provider that you feel comfortable talking to about anything and that partners with you in your health. I would recommend African American women find providers that they can develop a partnership with and help them reach their health goals.
Unfortunately, many screening guidelines are generalized and do not always account for the health disparities that exist in African American women and other individualized factors, so it’s important to be aware that the screening guidelines are not set in stone. If you believe that you should be screened at an earlier age than what’s recommended, have that discussion with your PCP. And it is not just a one time discussion, have an ongoing discussion about screening guidelines and what might be best for your individual circumstances.
I would also add that it’s important to practice the healthy habits you would to reduce risk of any disease, not just cancer. That means not smoking, limiting alcohol consumption, maintaining a healthy diet, staying physically active, exercising at least 30 minutes a day, and keeping your stress level low. We live in a really high stress environment now, so it’s important to find healthy ways to manage your stress levels. Those lifestyle changes will lower your risk for most diseases.
The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, Portland, the San Francisco Bay Area, Seattle, and Washington, DC.
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