Breast cancer is less common among Hispanic/Latino women than among their Caucasian and African-American sisters. That may at first sound like good news, but breast cancer is also the leading cause of cancer death among Hispanic/Latino women, and their five-year survival rates remain lower than those in other ethnic groups. These troubling statistics may be due in part to insufficient access to health care and insurance. But many health educators attribute poor outcome in Hispanic and Latino women to certain cultural beliefs that act as obstacles to early detection, and discourage open and proactive management of breast cancer.
Below, Dr. Amelie Ramirez, a member of the Susan G. Komen Breast Cancer Foundation National Hispanic/Latino Advisory Council, behavioral research expert and Associate Professor of Medicine at Baylor College of Medicine, talks about the special challenges that Hispanic/Latino women face in coming to terms with screening and treatment, and a culture that has allowed breast cancer to remain shrouded in myth and silence.
What is the prevalence of breast cancer in the Hispanic/Latino community?
Breast cancer is the leading cause of cancer death in Hispanic women. About 70 per 100,000 Hispanic women are afflicted with breast cancer every year, but these rates are lower than in Caucasian and African-American populations. We don't know exactly why this is. There may be some protective factors that Latina women have, but also, Hispanic women are sometimes counted as White or African American, so there is some concern that the rates of breast cancer in this community are not being appropriately counted.
Is it true that Hispanic/Latino women with breast cancer are often diagnosed at later stages?
Yes. They put off coming in for early detection and screening, so when they do come in at this later stage, the tumors are much larger and are very difficult to treat.
What are some of the obstacles in getting Hispanic/Latino women screened?
Education about the importance of breast cancer screening is a major obstacle in this population. There have been very few bilingual education programs that are reaching this community. There is also a lack of insurance in this population, which presents another barrier. Often, screening is not covered in their primary insurance, or they simply don't have insurance. Often, Hispanic people don't qualify for insurance. They may have two part-time jobs, neither of which provides insurance.
Are there any cultural barriers that might prevent Hispanic/Latino women from getting screened?
Some Hispanic women have been brought up in a culture that frowns on women touching themselves, so many of these women are less likely to do the breast self-exam. Also, if a Hispanic woman has a male physician, often she is reluctant to let him do a breast exam. Or her husband is reluctant. Additionally, Hispanic women often just don't talk about breast cancer, and they feel that if something irregular is found in a screening, that it is always cancer, which is not true.
Hispanic women also tend to put themselves last in the family for care. If there are few resources left after the whole family is taken care of, then perhaps she'll go in for screening. But her preventative care comes last.
Do Hispanic/Latino women get regular mammograms?
Only about 40% of Hispanic women are utilizing mammography, and we don't understand all the reasons. There are some misconceptions out there that it hurts. Some women have said it's like a tortilla press. So there is a real lack of education about the usefulness, and experience of screening.
What are some of the myths about breast cancer that are prevalent in the Hispanic/Latino community?
Some people believe that if you have a bruise on your breast that it will lead to breast cancer. Some people believe that getting too many mammograms will lead to breast cancer. Some believe that touching the breasts too often will lead to cancer. Some Hispanic women believe that if they talk about cancer, it is more likely to happen. We need an outreach program that utilizes mass media, radio and television, newspapers and printed material, in addition to doing educational seminars in the community.
Does language pose a problem in terms of getting information out to women about breast cancer and screening?
Yes. Particularly older Hispanic women prefer their information in Spanish or in a bilingual format. They're just more receptive to receiving this kind of sensitive information in Spanish. And often, women are afraid that they won't understand their doctors, or that the doctors will talk too fast. They are concerned that they won't be able to explain what they are feeling. We need health providers to understand that it is important to allow Hispanic women to tell their stories and listen, preferably in Spanish. And if the doctors are speaking in English and it is not the patients' first language, they could talk a little bit slower. I've heard women say, "I was told I had breast cancer. Before I knew it the doctor was out the door and I couldn't really understand what he had said."
What are some of the barriers to getting good breast cancer treatment?
It often comes down to cost, or lack of insurance. A lot of times when women are told that they have breast cancer, they will try alternative therapy. They might go across the border or try it on their own, and then come back and get care in the United States. Sometimes it's too late then. The tumor has advanced.
Are Hispanic/Latino women aware of investigational medications?
Clinical trials sometimes offer the best therapy available, so helping Hispanic women understand what they are, and how to get involved is critical. But sometimes when they go to community physicians, those physicians are not part of the clinical trial network, and the women don't find out about the trials. It's really important that they ask their doctors, "Are there any clinical trials for breast cancer that I can participate in?" I think we haven't done a good enough job in getting that word out.
What can Hispanic/Latino women living with breast cancer do to get the word out about early detection and treatment?
They can get involved and engaged. There are very few support groups for Latino women, so starting support groups is a great idea. They can share information about the resources that were helpful to them. And they can serve as positive role models not only for their immediate family, but their extended family and the community. It is often so taboo to talk about breast cancer, and people need to get comfortable talking about it.
Young women can help their older moms. Grandparents often don't come in for screening because they think they're not at risk. But we know that breast cancer also affects older women, so that we need to encourage younger women to encourage their mothers and grandmothers to come in for screening, and receive the care that they need.
We need to make 'breast cancer' a household word, and a topic you can talk about with your mother, your aunts, and your sisters. And we need real people from the community to get out there and say, "You know, I was able to conquer this. I was able to do something about it, and so can you."
