Addressing Breast Cancer Inequities

By Christine Cupaiuolo — September 4, 2008

Our Bodies Our Blog has invited the folks at Breast Cancer Action to write monthly guest posts on breast cancer and related issues.

by Brenda Salgado

Here’s an alarming statistic: African American women are much more likely to die from breast cancer than white women, and the mortality gap has actually widened over the past 20 years.

According to the California Breast Cancer Research Program, in 1980 breast cancer mortality rates were equal for both African American and Caucasian women. By 1990, however, African American women had a 16 percent higher mortality rate than white women, and by 2004 this difference had increased to 36 percent.

We should all be outraged by these figures.

This disturbing trend has led to a much-needed focus on determining why these differences — commonly referred to as “disparities” — exist, and what can be done to alleviate them.

Research on breast cancer disparities has largely focused on screening rates, access to health care, differences in treatment and, increasingly, genetic differences. While such research is important, it ignores other factors — such as social and economic injustices and racism — that also affect health outcomes.

In discussing the differences in outcomes, the Alameda County Department of Public Health in Northern California uses the term health inequities rather than disparities  to clarify that “differences in health … are unnecessary, avoidable, unfair and unjust” and related to “discriminatory actions, practices and policies that perpetuate diminished opportunity and hazardous exposures for certain populations.”

As health advocates, we’re engaged in efforts to eliminate these injustices. But in order to succeed, our efforts must be broad enough to include the root causes of breast cancer and go beyond focusing on the usual suspects of health care access and genetics.

In the United States, we seem to be particularly enamored with the idea that we can “unlock” the genetics of disease, and, in doing so, fix most of our health problems. But in going down this path, we must guard against the misuse of this information to stereotype communities.

As we seek to identify genes that may be predictive of disease, we may unknowingly turn our attention from talking about other issues like income, racism, access to healthy foods and neighborhood pollution. Like breast cancer mortality, these issues are not distributed equitably in our society, and there is already clear evidence that these factors affect multiple health outcomes.

Earlier this year, the Center for American Progress issued a report called “Geneticizing Disease: Implications for Racial Health Disparities.” The authors tell the cautionary tale of BiDil, the first race-specific medication targeted at African Americans, and the ethical, research and funding controversies surrounding its approval. They also make the case that placing all our emphasis on medicating disease once it has arisen will come at the cost of preventing disease from occurring in the first place.

We need to make sure our policymakers think more broadly than genetics research and health “disparities.” Resources also must focus on addressing the social injustices that lead to health inequities and on improving the social conditions of everyone in society.

Genetic research and biotechnologies have led to some important medical advances (in addition to creating profits for pharmaceutical companies). We need to make sure these new treatments and health technologies also serve public health and do not undermine our efforts to create a more just and fair society.

If not, we will never reduce that 36 percent difference in mortality. And it’s high time we did.

Brenda Salgado is the program manager at Breast Cancer Action. She manages BCA’s ongoing campaigns, oversees BCA’s legislative and policy work, and represents BCA on environmental and women’s health coalitions.

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