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Addressing Barriers to Care

Since embarking on this journey to save lives by urging women to get screened for breast cancer, I’ve given the crucial message many times that breast cancer mortality rates are higher among women of color. In response to which comes the inevitable question, why is that?
For many it’s denial. One woman even recounted that her aunt had been diagnosed with breast cancer but did nothing about it. She basically denied herself to death. Can we really accept that? Life is precious, sacred even according to my faith. Can we simply stand by and allow someone to decide not to act on a diagnosis like this? Of course this brings up a host of controversial issues that I’m not going to attempt to address here, but seriously, no woman is an island (apologies to the original author). We are all connected, hopefully loved, counted on by our friends, our partners, our children, our fellow church members, our nieces and nephews. They depend on us and they care whether or not we live or die.
We also have denial by not getting screened in the first place. This is akin to saying if I don’t feel sick and I don’t know I’m sick, I don’t want to ruin it by actually finding out that I am. Silly as it seems, I can understand this logic. Life is going fine, do I really want to face an unpleasant truth about (fill in the blank)_________ my child’s drug use, my husband’s infidelity, the fact that a flood is coming, I have cancer, etc? Happiness is bliss, right? (sorry to use yet another cliche’) But the reality with all the things we want to avoid is that facing them early on can make a huge difference. We women are good at denial though. It may not be healthy but it’s out of an instinct for self-preservation because the truth can often be too hard for us to bear.
So, we’ve covered denial. What about more practical reasons? Some people are uninsured, and with the way the Affordable Care Act is becoming less affordable this time around, that number could rise again. Mammograms are fully covered by most insurance plans and covering the out of pocket cost of a mammogram to simply screen for cancer, is not likely to be in the budget of many people I know. This is a very real issue because one of the great things about health insurance is that it encourages people to get all the recommended screenings. We have annual physicals, women’s wellness exams, mammograms, colonoscopies, eye exams, and twice yearly dental check-ups. These visits also encourage us to get to know our providers better, thus forming a trusting relationship. Many people belong to cultural or ethnic (and yes, gender) groups that don’t see the doctor unless they are sick. Since, ideally this is an infrequent occurrence, we are seeing a virtual stranger every time we go in for the proverbial sore throat or hang nail. This hardly fosters trust even in the best of circumstances. So with a cultural history of distrust between traditional authority figures (doctors, police, teachers) and average Black citizens, the motivation to go to the doctor just isn’t there. Maybe I’m overweight or have a chronic ailment such as diabetes or hypertension. Will the doctor criticize me? Avoid looking me in the eye, or worse, blame me for my condition? Again, under the best of circumstances, the average person doesn’t enjoy getting on the scale at the doctor’s office and likely has the blood pressure rise a few points just by having it taken. When you add the stress of racism (whether actual or just anticipated) to the mix, then who can blame a person for preferring to stay home rather than opt for a screening when they feel fine?
Barriers such as transportation, lack of primary care physician, education and such can also be a problem but these are much more straightforward and easily addressed. What isn’t so easy is to convince someone that she deserves to have a mammogram and that she’s worth it in spite of the difficulties.
What barriers keep you or those you care about from getting screened? I’d love to hear your thoughts.

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