Excluding women of colour from breast cancer awareness campaigns isn’t just irresponsible – it’s deadly
Initiatives to encourage women to take this seriously are urgently needed. But given the serious healthcare inequalities ethnic minority women face, they also need to be intersectional
Pink boobs. Giant inflatable pink boobs. This is the image that popped up on my Twitter feed a few days ago. The boob bus is a campaign launched by Lorraine Kelly for the Change and Check breast cancer awareness campaign to coincide with Breast Cancer Awareness month this October. My boobs don’t look like this, is what came to my mind. It might be too much information, but that really is the first thing that popped up in my head, not that I need to check my breasts for signs of cancer.
I could not take this message seriously while I was faced with this undeniably white version of human mammary glands. They also do not look anatomically accurate, but perhaps the designers could be forgiven for this. After all, they aren’t meant to be entirely realistic and there are practical considerations to take into account. However, the colour of these “model breasts” and the imagery that is being used in this campaign is far from inclusive. There is already a huge bias in breast cancer screenings. Non-white women are less likely to be diagnosed at an early stage. Research has shown that black women are 45 per cent more likely to die of breast cancer compared with white women, even though the rate of occurrence is similar.
According to the American Cancer Society, the incidence of breast cancer in African American women is slightly lower than white women but their mortality rates are higher. Between 2009-2012, the incidence of cancer in black women was around 124 for every 100,000 women, compared to 128 for European American women. However, the five-year survival rate between 2008-2011 was 80 per cent for black and 91 per cent for white women. In a study carried out in 2012 at the Mount Sinai Medical School, New York, it was seen that Latina and Indian women are less likely to receive hormone therapy – which decreases the risk of recurrence of breast cancer – than white women.
The disparity in survival rate is largely attributed to later stage detection among minority ethnic women, as is the lack of adequate guidance and support during screening and after diagnosis. There are also disparities in the mammography screening rates for women from different cultural and religious backgrounds. This could be an indication of health care inequalities but also systemic racial inequalities, that I discuss in much detail in my upcoming book SWAY. Minority ethnic women do not feel as confident in going to seek medical care – possibly because of the fear of being stereotyped and discriminated against – or they do not focus on themselves because they believe that they are not worth it – a materialisation of ingrained racial marginalisation. Disparities in access to healthcare, location of healthcare services, and support to follow up with appointments are all part of broader structural racial inequality.
The data from the National Cancer Diagnosis and Analysis in the UK shows that the compulsory screening age of 50 can sometimes be too late for women from black and south Asian communities. For women of colour, the median age of diagnosis was much lower at around 50, compared to 62 in white women. Black women were also more likely to have high grade tumours when first diagnosed. Sixty-two per cent of these patients had Grade 3 tumours compared with 50 per cent of white women, showing that early screening and diagnosis is an issue for minority ethnic women. A study published in JAMA Surgery in 2018 shows how traditional screening tools and guidelines do a disservice to women of colour. The study comprising 748,000 women (aged 40 to 75), looking at cases of breast cancer in the USA between from 1973 to 2010, found major differences regarding age at the time of diagnosis between races: 59 for white women, 56 for black women and Asian women, and 55 for Hispanic women. These might seem like relatively minor differences, but they add up to a whole lot when we consider them over the whole population.
Cancer must be diagnosed early if we want to increase the rate of success. We have to acknowledge the reality that some women are less likely to go for medical check-ups or seek medical care because they do not feel as confident and they do not understand the risk of breast cancer. Some women are also fearful of being mistreated or facing prejudice. There are also cultural, religious and language differences, and different perceptions of pain, which makes diagnosis difficult. Initiatives to encourage women to take breast cancer seriously are commendable, and urgently needed. But they also need to be intersectional and acknowledge the unique challenges and experiences of women of colour.
Mammography screenings are important for all women, irrespective of race. Breast cancer is a killer. But it is a well-accepted fact that representation matters. This campaign which seems to be targeted at white women, is less likely to motivate all women to get their breasts checked. Campaigns such as this have a responsibility to be inclusive. Breast cancer does not see skin colour. But people do, and it matters to them.
Dr Pragya Agarwal is a behavioural scientist and diversity consultant. She is the author of ‘SWAY: Unravelling the Science of Unconscious Bias’ coming in early 2020 with Bloomsbury Sigma which can be pre-ordered here