Educate, Evaluate, Empower: Breast Health for Black Women by Black Women

June 23, 2022 annieparkerfoundation

Clinical Data, Health & Wellness, Healthcare, Healthy Lifestyles, Medical Communications, Medical Interventions, Nutrition

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By Patricia Thangaraj

Breast cancer is the most common cancer among Canadian women (not taking into account non-melanoma skin cancers) and the second leading cause of death among this group. While men are also susceptible to breast cancer, it is rare, according to the Canadian Cancer Society.

Research 2 Reality indicates Black women face far worse outcomes than other demographics according to research from the U.S.A. and the U.K. Yalinie Kulandaivelu of Mommy Monitor goes on to say that while Black women have similar, if not lower rates of breast cancer compared to White women, the mortality rate for Black women with breast cancer under the age of 50 is double than that of White women of the same age.

Further data for the USA shows that Black women of all age groups have a breast cancer mortality rate that is 40% higher than White women. Additionally, Black women have the lowest survival rates of all racial and ethnic groups at every stage of the disease. This difference is most prevalent at stages III and IV of the disease. For every subtype of breast cancer, Black women have survival rates that are 5% to 7% lower than other racial and ethnic groups, adds Kulandaivelu.

Yet in spite of these disparities, there continues to a lack of Canadian race-based data, according to both Research 2 Reality and Dr. Aisha Lofters, Chair in Implementation Science, The Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital (WCH).

Photo compliments of Women’s College Hospital (WCH)

The Healthcare Blog explores the case of breast cancer for Black Women in Canada.

Black Women: The Definition

Black women are women of Sub-Saharan African and Afro-diasporic descent. It includes those who self-identify as Black, African, Caribbean, African-Canadian, Melanated, members of the African Diaspora and other persons. The term is used for all those who self-identify as Black women. The term is also inclusive of gender identity, sexual orientation, age, ability, socio-economic status, migration status, language, culture and religion, according to Dr. Lofters.

Canada’s Black Community

3.5% of Canadians are Black. And more than a half of those 1.2 million people were born in other countries. They come from all across the globe, with the majority of them coming from the Caribbean and the African continent. While they are a global and diverse group, for the purpose of this Blog, they would to be considered as one unified community.

See map from Statistics Canada

The Breast Cancer Journey

Speaking specifically about breast cancer, the Cancer Journey as envisioned by Cancer Care Ontario starts with prevention and makes its way to screening, diagnosis and treatment. From here on it is recovery/survivorship or end-of-life care. And there are known disparities for Black women across all aspects of this journey, said Dr. Lofters.

Disparities and Lack of Canadian Race-Based Data

In the United States, studies have shown that Black Women are:

Less likely to be screened for breast cancer with mammograms.
More likely to have more aggressive breast cancers.
More likely to be diagnosed at a younger age.
More likely to wait longer to start treatment for their breast cancer.
Less likely to get the most appropriate treatment for their breast cancer.

The Chair in Implementation Science at the Women’s College Hospital (WCH) explained that she was highlighting the American data due to the fact that there is very little race-based data in the Canadian context. She stated however, that many scholars and community advocates are calling for the collection of race-based data, which would enable research specialists such as herself to study areas such as breast cancer.

She also revealed that institutions are listening. Many healthcare organizations are now starting to gather race-based data. This would take time. However, what they do have at their disposal currently are the stories of Black Canadians and they do have some other data that speaks to these disparities in Canada.

Ontario Disparities

In Ontario, studies have shown that:

Women who have immigrated from the Caribbean and Latin America are more likely to have regular mammograms, but still have a longer time for diagnosis, are diagnosed at a later stage, and have a longer wait time to start chemotherapy.
Women who have migrated from Muslim-majority countries in Sub-Saharan Africa are less likely to be screened with regular mammograms.
Women who have immigrated from Sub-Saharan Africa in general are less likely to be screened and wait longer to start chemotherapy.

She said that this not only shows disparities, but also a need for improvement in these areas.

Nova Scotia Disparities

In Nova Scotia,

Black women are less likely to get mammograms than White women.
Black women have reported that barriers to getting mammograms include difficulty navigating the healthcare system and experiences of racism from clinicians.

Knowledge + Action = Power

Dr. Lofters said that while disparities are important to know because they provide a strategic direction on how they should move forward in addressing both the healthcare inequities and healthcare equalities in Canada, the goal of both The Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital (WCH) and the Olive Branch of Hope is to provide Black Canadian women on concreate action steps that they can take for both prevention and treatment.

While most of the work needs to be done at the system level such as collecting race-based data and ensuring that healthcare providers actually utilize this data once it has been collected, to acknowledge and analyze the disparities that clearly exist in Canada’s healthcare system and what actions they can take both on an individual level as well as an organizational level to ensure that these disparities are addressed, resulting in better outcomes for Black women is imperative.

Concreate Action Steps for Black Canadian Women

Alcohol

The WCH Physician said that alcohol use has gone up during the pandemic and mixed messages continue to exist on whether alcohol is good or not good for a person’s health and well-being. The current recommendation is less than one glass a day and even less is better. For those who want to know how they can reduce their alcohol intake, the Canadian Cancer Society (CCS) has resources on their website to help persons do this.

Hair

Hair is very important for Black women. There are research studies that have shown that chemicals used in certain products such as hair straighteners and relaxers like those containing lye can actually increase one’s risk of developing breast cancer. Dt. Lofters said that they recognize that hair care and hair styles are personal choices, but they would recommend that Black women talk to their hair stylist about the products that they are using to make sure that they do not contain any chemicals or other ingredients that are not safe.

Exercise

Regular physical exercise can also reduce one’s risk of breast cancer. The recommended time is at least 30 minutes of exercise every day in an activity that you enjoy doing. Find something that you can commit to, gets your heart rate up and brings feelings of both physical and mental well-being, she stated.

Smoking

Dr. Lofters said that persons often think of smoking as a risk factor for lung cancer. However, they know that it can be a risk factor for breast cancer as well. The Canadian Cancer Society has great resources on their website for those persons who want to quit smoking.

Healthy Diets

Minimizing processed foods and reducing refined carbs can redound in many advantages including reducing your risks of developing breast cancer. The WCH Physician stressed that eating healthy does not mean that they have to eliminate the culturally diverse foods of African heritage that they love. In fact, many of these culturally diverse foods have vegetables, legumes, fish, using spices to season food install of salt and fruits. The African Heritage Diet Pyramid, which is available online provides an excellent starting point.

She added that while these steps can reduce your risk of developing breast cancer and are good for maintaining overall positive health and well-being, there are still women who get breast cancer who do all of the right things just like there are women who do all of the wrong things, but never get breast cancer. Therefore, a woman who gets a cancer diagnosis should never feel – or be made to feel – as if she has done something wrong. The information that they provide persons with is not to “shame them, but to empower” them.

Screening for Breast Cancer

Screening for breast cancer means finding a cancer early on or finding pre-cancerous changes before any symptoms appear. They screen for breast cancer using a mammogram, which is like an X-ray of the breast.

Dr. Lofters said that many women opt out of getting a mammogram because they do not want to know or feel that they are not in a position to handle a cancer diagnosis at this stage in their lives as they have other things going on. However, she emphasized that screening is just a way of “shining a light on what is already there. It is allowing us to open our closed eyes and see what already exists and very powerfully, screening allows us to catch what is there before it progresses.” It also presents an opportunity for women to chart a different path for themselves and their future.

Ontario’s Breast Screening Locations

If you are between 50 and 74 years of age, you can book a mammogram directly. You do not need a referral. If you are under 50 years or over 74 years, you would need a referral, so it is best that you talk to your primary healthcare provider about if and when screening is right for you. If you are not in Ontario, Dr. Lofters advises them to conduct a Google search to find out the options that are available to them in their province and/or city.

If you live in Ontario, The Cancer Care Ontario website provides you with a map of where you can go to get screening. Simply log onto their website and type in your location.

Breast Cancer Prevention: Knowing Your Family History

Knowing Your Family History is another powerful arsenal that women can arm themselves with in their fight against breast cancer. It is imperative that you know your family history on both sides, especially those relatives who have had breast and/or ovarian cancers as well as other types of cancers.

Dr. Lofters said that in many African cultures, talking about breast cancers – and cancers in general – is a taboo topic and therefore, many persons would not talk about it. In fact, many persons have relatives where the cause of illness and/or death is a “mystery” Yet, it is important for you to know your family history because they can help you to take preventative measures such as starting screening earlier or being screened more frequently. If persons share their family history with their healthcare provider, then these physicians can be more proactive in investigating any symptoms that their patients may have.

“So, ask questions, explore and investigate. If anyone on either side has breast or ovarian cancer, if anyone on either side has any type of cancer.” The risk levels go up if there is more than one person on either side of the family or if your relatives were diagnosed at a younger age. This could mean that there are certain gene mutations that exist in the family, she said.

BRCA1 and BRCA2

BRCA1 and BRCA2 are two of the most well-known gene mutations and these gene mutations are also seen among Black women. “There is a perception that these mutations only exist among White women, but that is not true. We see them in all races and all ethnicities,” said Dr. Lofters.

BRCA1 and BRCA2 are not the only gene mutations, there are many others also. So, it is advisable that a person with a strong family history start mammograms at age 40, or 50 or 10 years before the cancer was diagnosed in the closest family member, she stated.

Therefore, if you find out that you do have a strong family history, it is imperative that you start having a conversation with your healthcare provider about your history, which is a great first step that persons can take.

Genetic Testing: Are you covered?

Genetic testing is also available for at-risk persons. However, some people and even some healthcare providers are unaware of this fact. In Ontario, if you have The Ontario Health Insurance Plan (OHIP), then you are covered for genetic testing, providing that you meet certain criteria. Two of these criteria include a having a strong family history of cancer and having a family member who was diagnosed at an earlier age. So, speak to your healthcare provider about conducting research to find out if you meet those criteria, said Dr. Lofters.

She added that most women who develop breast cancer do not have a family history. So not having a family history, does not mean that you are not exempt, just like having a family history does not automatically signify a death sentence, especially if you are proactive.

Talk to Your Healthcare Provider: Advocate for Yourself

Having a healthcare provider with whom you are comfortable sharing information with is crucial. However, they recognize that this is not always the case for Black women, said Dr. Lofters.