Racial Disparities in Stage at Dx Linked to Lack of Insurance

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Racial Disparities in Breast Cancer Stage at Diagnosis Linked to Lack of Insurance
January 14, 2020
A large percentage of the difference in breast cancer stage at diagnosis between white women and women of other ethnicities seems to be affected by whether a woman has insurance. Read more...

dreaming

I will comment from my experience as an advocate, activist for breast cancer, retired after 30 years from a cancer center, member of boards for Cancer for the underserved,diverse population.

It is all cultural ,an American black lady will not act the same as black lady from the Caribbean, Colombia,Brasil,Africa when it comes to their health, cultures,values,traditions are different.

While I was active in a cancer organization that targeted culture, I created a program of volunteers to teach in high school about cancer,symptoms, care,because the young could explain and teach parents.

We also sent volunteers to places where women meet to teach like churches.

We were very succesful.

We had a yearly Conference to address with role playing believes about health in different communities based on religion, ethnicity, culture.

We have community clinics, that diagnose for free, mobile mammography free, check local hospitals there are months for free breast exams,skin cancer and so on.

I collaborate with The Rose in Houston years back, a clinic example of dedication to the health of the underserved that are people with no insurance.

Once diagnosed one can qualify for Medicaid or Hospital Charity care.

One has to be responsible for one life, get second opinion, every hospital has social workers that work with patients that can have financial, insurance, work problems.

One reason why we get many coming to the USA to be treated because there are many options for who do not have medical insurance.

I believe is more a socio economic,cultural problem ,not a race problem.

SummerAngel

If a person is poor and has no insurance they are unlikely to see a doctor as they should. Unfortunately more minorities fall into this category than white people. It's not "cultural", unless you consider the "culture" of the US having a health care system that leaves a lot of people behind. As far as the "many options" for those without insurance, I'd like to hear from people who have actually used these options. Do people even know they exist? Are they easy to find and sign up for? My sister is poor and she hasn't been to the doctor (or dentist) in many years. She would rather ignore any issue she has in the hopes that it will get better on its own because she knows she can't afford treatment. She would probably go to the doctor if things got bad enough, but that's it. She worked at Goodwill with a woman in the same boat. This woman knew she had a lump in her breast for a very long time before it got bad enough to seek treatment. By then she was stage IV and died less than a year later.

Beesie

I read this thread out of interest and probably shouldn't comment since I am not a racial minority, but here goes anyway...

I think you are both right, in that I think both poverty and culture are factors as to why someone might not see a doctor. I live in Toronto, which is a very multicultural community, with over 50% of our population being foreign born, and these issues regularly are front and center in the news. For example, because there is a distrust of the medical system within some cultural groups, right now there is a major effort underway within certain ethnic communities to ensure that people get the Covid vaccine when it is available to them (which for most people in Canada unfortunately won't be for quite a while yet). We have a large Muslim population, and the availability of female doctors (and better still, female Muslim doctors) is critical to ensuring that women within this community see a doctor when they need to. Just two examples.

The following webpage is specific to children, not women with breast cancer, but it highlights the role of culture in medical care:

How Culture Influences Health A guide for health professionals working with immigrant and refugee children and youth

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As for poverty, obviously that is a huge issue when it comes to health care, although probably less so in Canada than in the U.S., because we have universal healthcare. Still, we face issues with having two few doctors located in poor urban areas (and more generally, within rural communities throughout the country), which means that if there is no doctor available to see, it doesn't really matter that it costs nothing to see a doctor. Someone who is struggling with 2 or 3 jobs and can't afford to take time off might visit a doctor who is conveniently located, but they aren't going to go to the trouble of searching for a doctor outside of their neighbourhood, or take the time and incur the expense to get to that doctor.

To the original post, I don't know whether in Canada we have the same issues with racial disparities in breast cancer stage at time of diagnosis, but I do know that overall we do have similar issues in terms of differences in medical care and outcomes for racial minorities. So while insurance is one factor that drives these differences in the U.S., there is obviously more to it, since we don't have the same insurance issues in Canada but we have the same problem.

Anonymous

I do think it's a mix of both culture/education plus the lack of insurance. And can we also talk about the quality and availability of care where poor people live?

You can have Medicaid or an insurance card and still face long waits for appointments, crowded waiting rooms, referrals to facilities that are distant, that require transportation, OR...that provide inferior care.

I am not black but I do have the experience of being uninsured at the moment I found a lump in my breast.

Getting to Planned Parenthood for the breast exam and mammography referral was easy. Everything else about that “journey" was not easy and if I hadn't had the advantage of my education , some prior knowledge of resources and my assertive personality it might have taken much longer than two months to get into treatment for cancer.

Getting everyone insured would be good but it doesn't solve all problems.

Let me add - about “cultural” issues - despite education, I had my own trust issues around the medical profession and I never went for routine mammograms, even though, when I first became old enough, I had employer provided insurance.

My gyno visits were free and I did go for my yearly visits but I used to throw the mammo referrals in the garbage as soon as I left the office. Go figure. I thought I was cancer proof and that the mammos would needlessly expose me to radiation. ¯\_(ツ)_/¯. I can relate to people having trust issues for whatever reason.