A Million Pink Ribbons Have Done Nothing for Black Women

Pink crap-drunk America was busy Racing For The Cure for the last 30 years, one race has been left behind in the fight against breast cancer: black women. In 2013, black women are still twice as likely to die from the disease than their white counterparts. Twice. As. Likely. That’s a fucking disgrace.

The New York Times features an examination of the racial disparity in breast cancer deaths today, citing several reasons black women have been left behind, and the years-too-late steps breast cancer charities and community organizations are taking to address the problem.

The long and short of it, according to hospital officials and researchers, isn’t that cancer interacts differently with the cells of women with African heritage; it’s that black women aren’t as likely to catch cancer early as white women. They’re not as likely to go to the doctor, because black women are less likely to be able to afford the doctor, and more likely to distrust a medical system that hasn’t exactly proven itself trustworthy to the African American community.

For years, America’s piss-poor for-profit healthcare system that kept preventative care out of reach of people who needed it to live. Prior to the Affordable Care Act’s inroads into decoupling insurance and employment (or extreme poverty), black women, statistically, were less likely to work jobs that came with cushy health insurance that would pay for mammograms. To paraphrase the Times, the poor are also less likely to work jobs that afforded them the time off they’d need for medical care, even if they did qualify for Medicaid. (Say what you will about the “rocky” rollout of Obamacare or pajama boy or whatthefuckever smarmy political Twitter is beating to death today; at least Obamacare is making progress toward a country where people don’t die of cancer they could have cured had they caught it early.)

There’s another, sadder reason black women don’t go to the doctor: they distrust the medical system. And for good reason — America has an incredibly shitty record of treating black people’s bodies as though they’re public domain. The Times piece mentions the Tuskegee experiment, where doctors (under the direction of the US Government) let black men who were receiving free health care from the government go untreated for syphilis for decades, but doesn’t mention something that’s probably a lot more relevant to black women in the South today: forced sterilization.

From the 1920’s into the 1970’s, various states forcibly sterilized thousands of women deemed unfit or undesirable for reproduction. Some didn’t find out until they tried to have children again that they’d had a tubal ligation, or hysterectomy. Those sterilized by the government were disproportionately poor, and disproportionately black. Is it any wonder that women a generation or two removed from this would give the American medical establishment a hearty side eye?

To combat this, Avon’s breast cancer charity and Susan G. Komen For The Cure have both began working with community leaders in cities like Memphis, using churches as bases for outreach, funding free mammograms, and working to figure out how to get black women to go to the doctor. Here’s one success story, kind of.

One afternoon this fall, the Boulevard Church of Christ hosted a health fair, giving away pink bags that included pink pens, a key chain and a brochure from the American Cancer Society. It prompted Ms. Singleton to seek a free mammogram through the local health department. She learned she had Stage 4 cancer in October.

Ms. Singleton has since begun treatment and counseling. She’s fighting. She’s talking about it. She’s relying on her family and friends. All good things.

While encouraging individual empowerment in the fight against breast cancer is objectively positive, heaping blame for a higher death rate from breast cancer on black women’s hesitance to go to the doctor isn’t exactly fair, either, as doctors (and the hospitals and clinics that employ them) are far from infallible entities without bias. In fact, a 2012 study found that 2/3 of doctors harbored some form of racial bias against patients, especially toward black people. Researchers found that doctors (even the ones who tried very hard in their outer, conscious lives to Not Be Racist by practicing in low-income and underserved communities) tended to be less attentive to their black patients, to dominate conversations, and to spend less time with them. Further, many black women who die of breast cancer are on government assistance, and doctors have a demonstrated track record of being hesitant to accept patients on Medicaid (one study found that surgical patients on Medicaid are 13% more likely to die in the hospital than those with private insurance, even when adjusted for age, race, etc). Doctors simply take better care of patients who can pay. And patients who are white.

Further, all the outreach programs in the world won’t end breast cancer as long as we know so little about why women get breast cancer, and as long as we continue to turn a blind eye to mass use of carcinogenic chemicals in everyday products. Screening black women for cancer and making sure they can get treated by a medical system that doesn’t back-burner their needs and lives to white women’s is a start, but fighting cancer rather than preventing cancer makes about as much sense long term as preventing fires by building more hydrants. Are people who can only afford to live where the rents are cheap more likely to be exposed to carcinogens? Is there a link between where low-income, uninsured black women live and the products they use and their rate of cancer? We should be racing for a cure, we should be racing to fucking pulverize cancer, to know its moves like an expert boxer studying an opponent, and to take it out before it even strikes.

So while getting black women to screen more aggressively isn’t a bad thing, it’s an incomplete approach to addressing the shameful survival gap between white and black women with breast cancer. Black women can come part way, but the establishment must meet them in the middle.