I went to the Google and did a search on breast self exams. My intent was to gather some illustrations of breast disease and exams and possibly write an essay about them. But my search results led me into another direction. As I was scrolling through the results it was what I didn’t see that troubled me.
Where are the women of color in these image results?
You would need to scroll through to page 7 of the results to see a black woman performing a self exam. Scroll further and one other picture of a black woman on page 9. One Asian woman on page 8. So pink ribbons means pink skin too? I was really troubled by this and started to dig a little deeper and it didn’t take long. This was a symptom of an even larger problem. Now appearances don’t tell you everything. Skin color is just that and any judgments based on that alone would be short sighted because pictures don’t tell you how a particular woman identifies herself in the multicultural makeup of the United States. But still. I came away from that search annoyed.
In August, Breast Cancer Research and Treatment published a retrospective study that concluded regular mammography could substantially affect the rates of breast cancer among black women compared to those of white women. Previous studies had shown that black women were often diagnosed with much later stage cancers (and lower survival rates) than white women. It seems obvious to say that early detection here saves lives. If Komen and other organizations are touting their success at spreading awareness, then why are these numbers so disparate? Is pink ribbon culture but one manifestation of white culture? But, wait, things aren’t usually that simple.
Before we can really talk about this we need to look not at skin color in a picture, but at the numbers. I pulled the following from the Centers for Disease Control.
Female Breast Cancer
Incidence Rates* by Race and Ethnicity, U.S., 1999–2008
When I first read this I thought perhaps the numbers would more or less be consistent with the percentage of population. But then look at the death rates from breast cancer.
Female Breast Cancer
Death Rates* by Race and Ethnicity, U.S., 1999–200
The original guess I had about numbers keeping pace with each group’s percentage of overall population was blown right out of the water. These numbers are so disheartening. Neither set of numbers includes any interpretation as to why these numbers would be so extreme, but the first study I cited may be just the tip of the iceberg.
Through Twitter, my new outreach tool, I became aware of the Sister’s Network. Founded in 1995, it is the only African American breast cancer survivorship and education organization in the United States. I have followed them for awhile, but I never went to the site. And it’s really awesome–you need to visit. And it, turns out, I found some information that may shed some light on the numbers.
All of our ethnic/racial/religious communities have different social, economic, cultural, and generational approaches to disease. Maybe that plays a role. The national slogan for Sister’s Network is “Stop the Silence.” According to the site this “speaks directly to the African American community and its longstanding history of not discussing cancer and other life-threatening health concerns.” All the more reason for the great work of this organization in educating members of the African American community. This may be a major factor in this disparity of breast cancer mortality rates within a culture. But it still doesn’t explain it all.
It turns out that African American women are more likely to be diagnosed with triple negative breast cancer. Some types of triple negative breast cancer are known to be more aggressive with poor prognosis. Also, the risk of recurrence is sharply higher in the first 3-5 years after treatment.
Okay, so there are sociocultural and biological reasons at play. Important considerations that shed light on the numbers. But it doesn’t explain everything.
I am still taken aback that a simple search like “breast self exam” shows more pink skin than a Connecticut country club pool party. Komen’s pages consist largely of white women. Their early detection video features pictures of white women throughout. Breastcancer.org’s illustrations are of white women. The National Breast Cancer Foundation is the only one that is consistently and thoroughly features women of all stripes–illustrations, though.
Look, I don’t have any answers, but this is gnawing at my soul. White, thin, pretty, and perky women aren’t the only women who get breast cancer. Women of all shapes and sizes get breast cancer. Women with breast cancer are well represented all along the economic spectrum. And women of all races get breast cancer. This is reality.
And that reality should be visually pervasive in the literature. When I do a search for “breast self exam” I should get the whole bloody rainbow of human kind. Not a female substitute for a pink ribbon.