When Harold Freeman, MD, set off around the country to find out why people of different races and ethnicities weren't getting cancer care, he assumed he'd hear about financial and geographic obstacles. And he did. What he didn't expect were the numbers of Americans who, for a variety of cultural reasons, wouldn't want screening or treatment anyway.
African-Americans have the highest death rate from breast cancer of any racial or ethnic group in the country.
In part because they're not getting diagnosed early enough. Fear keeps many from seeking screening. There aren't any African-American Nancy Reagans or Olivia Newton-Johns to reassure black women that you can lose your hair and it will grow back or lose part of your bosom and emerge just as sexy, loved, and confident as ever.
Religion is also an effective barrier in some communities, according to medical anthropologist Deborah Erwin. Twelve years ago she heard an elderly woman announce, "If God wants me to have a mammogram, he'll tell me!" Erwin decided then and there to work through the churches. Katherine Jahnige, MD, community outreach coordinator for the Siteman Cancer Center and director of the Witness Project in St. Louis, points to the Christian tradition of "claiming," which, in biblical terms, means you can speak something into reality (for many believers that translates into: Talk too much about breast cancer and you'll get it).
Latinas over 40 are the least likely of any group to have mammograms, according to the Society for Women's Health Research in Washington, D.C.
The biggest obstacles are lack of insurance and legal documentation, but some barriers are emotional. Sister Concha De La Cruz, a 62-year-old nun and pastoral minister for the Hispanic community of St. Louis, remembers growing up with other Mexicans in hot, dusty, Spanish-speaking El Paso. "Many Mexican women do not trust doctors to this day," she says. "They prefer to use herbs. And there used to be a culture of extreme modesty—'Nobody can look at me, nobody can touch me.'" For her generation, in fact, virginity was such a fragile treasure that even a doctor's gynecological exam was shunned lest it compromise a woman's purity.
"That is changing," Sister Concha says with relief, although some women do confide in her about husbands so macho they don't want their wife's breasts examined. Sister Concha sighs heavily, remembering how her own father refused to take her mother to the doctor. "He was extremely jealous. If the doctor wanted a follow-up appointment, he would say, 'Well, the doctor's fallen in love with you.'"