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Treating Breast Cancer Early

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PHYSICIAN VOICES
Living with Breast Cancer: What I Want African American Women to Know

Medically Reviewed By Alana Biggers, M.D., MPH
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As an African American woman, and as chief of surgery at City of Hope in Atlanta, GA, I have several decades of experience working with African American women living with breast cancer. All of the symptoms of breast cancer are pretty much the same among people of different races, but the outcomes certainly are not. African American women with breast cancer often have a worse prognosis Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source than white women with breast cancer. The mortality rate for African American women is 40% higher than that of white women with the same diagnosis. They often receive a diagnosis when their cancer has progressed to more advanced stages. There are a lot of reasons for these differences in outcomes. In order to receive the best care and change these statistics, there are a few things I want women to know.

1. Trust your gut

In my experience, certain marginalized groups have a justifiably harder time trusting the healthcare system. They may have had a bad interaction with a healthcare professional in the past, or they may not feel safe or respected when seeking care. This is a challenge because it can lead to them not seeking care in a timely fashion. 

In most cases, all women are being offered standard of care treatment options due to certain guidelines that are in place. We’re making headway as far as prioritizing cultural competency. That means, at a high level, that medical organizations are creating processes to evaluate the behavior of healthcare professionals, making sure that their organization is appropriate for their patients’ demographics. They’re reflecting on whether their process is working and if they have the right programs in place to support patients’ various cultural needs.

On the physician-to-patient level, cultural competency is really all about delivery. We must make sure that all cancer patients understand their cancer diagnosis, their stage, and the treatment regiments that are considered standard of care. In order to do that, physicians need to understand how a patient’s cultural identity influences how they interact with the healthcare system, and adapt to their needs. Doctors who are culturally competent work to make sure patients are fully engaged in their treatment process and are intentional about providing a trusting environment.

When it comes to finding the right oncologist, I always tell people: you’ll know in your gut if this is the right one for you. The right physician will be someone you feel comfortable with, because you may need to partner with that person for a long time. They will be someone who demonstrates cultural competency and who offers you all the treatment options that are most appropriate for your diagnosis. 

Of course, it’s very common to get a second opinion when it comes to cancer treatment. If a doctor isn’t happy with your choice to seek a second opinion, that’s a big red flag. If a doctor is in a rush to operate on you, that’s also a red flag. Find someone who takes the time to answer all your questions and explain all the details to you. Your gut will let you know when you’ve found the right fit.

2. Make sure you get the right treatment

The internet isn’t always the best place to find information, but if you’re looking in the right places, it’s helpful to understand as much as you can about your diagnosis and next steps. I always recommend the American Cancer Society as a place where patients can begin. 

There are a few things that certain ethnic groups should consider when it comes to treatment options for breast cancer. They may be at a higher risk of developing keloids after surgery. Keloids are thickening and scarring of the skin. It’s important for your doctor to know if you’ve developed keloids in the past, so make sure to mention this if you have. If keloids are a factor for you, we’ll be very gentle when we operate.

Also, research indicates Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source that African American women aren’t always offered all reconstructive options. The data clearly shows Trusted Source JAMA Peer reviewed journal Go to source that women with early stage breast cancer, whose disease is in just one part of the breast, can keep their breast intact via lumpectomy. And not everyone knows that most women are candidates to get some type of breast reconstruction the same day if they have received a mastectomy. Today, women who prefer to keep their breast intact can have an optimal cosmetic outcome.

Additionally, certain marginalized groups are significantly less likely to be invited to participate or included in clinical trials for new treatments, so I encourage you to ask your doctor about any clinical trials that might be the right match for you. All cancer patients should know that in the majority of therapeutic clinical trials, you are given an additional drug in combination with the standard drug regimen. 

I want all patients to know that today, oncology treatment is tailored specifically to them. Our goal is to provide you with state of the art care, and treatment options can change rapidly. Your treatment may be different from your family member’s or your friend at church’s. The guidelines have changed, and you may have a totally different diagnosis than that person. The good news is that treatments have advanced and continue to do so, so your options may be less invasive and more effective than someone who received treatment years ago.

3. Lean on nurse navigators

Nurse navigators, or patient navigators, are members of your healthcare team who are there to walk with you every step of the process. You’ll meet with your doctors and nurses regularly, and navigators will be there during those appointments and also available to you afterwards. 

When you receive your diagnosis, they will educate you about next steps, like which doctor you’re going to see, what tests you need, and which follow-ups you need. They are there to answer any questions your doctor may not have discussed, and they can offer support in many other ways, as well. 

4. Take care of your mental health

Finding ways to manage emotions during this challenging time is key. Sometimes, certain marginalized groups may hold a stigma about reaching out for help, but it’s important to recognize this is a difficult time in your life. Depression, anxiety, and stress are all real feelings you can allow yourself to feel. Know you are not alone. If you’re feeling stressed out, have lots of anxiety, or are having trouble sleeping, reach out to your doctor. They can refer you to a mind or body therapist or a psychologist, who can prescribe treatments to help you through the process. This doesn’t mean you’ll be taking medication for a long time. It can be temporary to get you settled. The most important thing to know is that being fearful about what’s next, and dealing with anxiety and depression, are all normal reactions to living with breast cancer, and you can find support.

One thing about breast cancer today is that the treatment has evolved. Not all women need chemotherapy, targeted therapy is very effective, and people who need radiation often receive it for less time than in the past. Our understanding of the mechanisms of breast cancer are evolving significantly, so outcomes are better and your treatment experience may be better, too.

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Medical Reviewer: Alana Biggers, M.D., MPH
Last Review Date: 2023 Jun 27
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