Gendered and Racialized Social Expectations, Barriers, and Delayed Breast Cancer Diagnosis

Authors: Sage, K. et. al.
Source: Cancer doi.org/10.1002/cncr.31636

Several studies have shown that black women are more likely than white women to be diagnosed with breast cancer at later stages. Additionally, outcomes from breast cancer tend to be worse among the former group. It is understood that one reason for these complex findings is healthcare access. Patient navigation (the presence of a professional who acts as a liaison between the patient and her breast care team) has been shown to improve breast cancer outcomes by being a constant source of support and direction for patients within the healthcare system. However, such navigation can only be successful if patients use it.

When a woman has an abnormal screening mammogram, it is vital that she have follow up to rule out cancer. For some women, there are barriers to this follow up–including social and economic inequality, fear of cost or pain and avoidance of possible bad news. If a woman can identify and report any barriers she has, a patient navigator can focus on overcoming these issues so that a woman can proceed with timely, proper care.

This study examined how women with abnormal screening mammograms utilized a patient navigation system for subsequent care. They looked for differences in use among different ethnic and socioeconomic groups. Just over 3700 women were included. Women who did not report any barriers were more likely to be black, live below the poverty line or have a higher level of distrust of the medical establishment. The rate of reporting barriers declined as the level of distrust rose. Nonblack women below the poverty line were more likely than black women below the poverty line to report barriers to care. Overall, women who reported barriers were more likely to receive follow-up to their abnormal screening mammograms.

These results suggest that proper workup of abnormal mammograms may be delayed (or not done at all) among women who do not tell the care team that they are experiencing obstacles to following physician recommendations. As black women below the poverty line were most likely to report no barriers, the investigators question the presence of bias. If these women did not trust the system, were conditioned to believe that they would not receive assistance or believed that they had to rely solely upon themselves, it follows that they would not tell navigators that they had barriers to their healthcare.

One way to improve breast cancer outcomes among black women may be to consider their self-imposed restrictions upon asking for help. Patient navigation systems that are aware of these women’s expectations may be able to change their methods and enhance outreach to them.