One week ago, my wife began chemotherapy. She was diagnosed with breast cancer in early December (not coincidentally, the same time this young blog went on an unanticipated hiatus). In the weeks since, we have faced a lot of fears that are a part of the cancer package. What would the tests show about the extent of the cancer? How would she feel during chemo? How would she cope with losing her hair–and potentially one or both breasts?
But there were also a lot of fears that we never had to worry about.
- We never feared that the illness would jeopardize the job she was about to begin or that I wouldn’t be able to take time off from work to care for her if needed. Both of our employers have been incredibly supportive, and when we do take time off, as salaried employees, we aren’t sacrificing hourly wages that we need to make ends meet.
- We never worried that she wouldn’t be able to get to appointments easily. We have excellent cancer facilities minutes from our home and reliable transportation to get there. My wife and I both have schedule flexibility; the most we have to contend with is arranging dog walks and remembering to turn the crock pot on.
- We never feared that the treatments could bankrupt us. We know exactly what our maximum out-of-pocket expenses will be with her insurance plan, and, while it’s not insignificant, it won’t be a financial hardship for us to get her the care she needs.
- We never feared that a restrictive insurance plan would keep her from seeing the doctors she wanted or that she would receive anything less than exceptional care. We’ve assembled a team of some of the best breast cancer specialists in Seattle-chosen after we had the opportunity to get a comprehensive second opinion. Our team has worked with us to craft a treatment plan that incorporates some of the latest advancements in cancer care.
- We never worried that we would be in this on our own. Even newly relocated to Seattle with family scattered around the globe, we have friends and colleagues in town who have rallied around us, we have visitors planned in the weeks ahead, and our families could be here on short notice to help if we needed.
- We never feared any stigma surrounding a breast cancer diagnosis. Quite the opposite. A Facebook group of hundreds of friends is cheering my wife on, and the cards and care packages have lifted both our spirits in some of the hardest moments.
At every step so far, we could say that we have been lucky or blessed (as odd as that sounds to say when talking about cancer). The reality is that we, as white women with stable finances and employment, have been privileged. That we HAVE privilege that many others do not.
From the moment of a breast cancer diagnosis, race is an undeniable factor. Black and white women are equally likely to be diagnosed with breast cancer, but black women are far more likely to die from the disease. Unfortunately, the disparity in mortality rates has only been growing in recent years. A recent study in the nation’s 50 largest cities found that black women with breast cancer were 40 percent more likely than white women to die from the disease, an even wider gap than the 17 percent recorded 15 years prior. Frighteningly, incidence of breast cancer in black women have been on the rise, even as rates overall have been declining.
What’s behind these stark disparities? A major factor is how early the disease is caught. Women from nearly every racial minority are diagnosed at more advanced stages of the disease; a black woman is 40 to 70 percent more likely to hear a stage IV diagnosis from her doctor than a white woman is. After diagnosis, she may face fewer options when choosing her hospital and doctors, meaning she is less likely to receive care from a medical team specializing in breast cancer. She is more likely to encounter delays in beginning her treatment, and she is more likely to have treatment that does not meet nationally recognized standards. A black woman with an income of less than $50,000 is also less likely to participate in clinical trials, denying her promising new therapies that could make a meaningful difference in her quality of life and survival. Many of these same hurdles to health are similar for other women of color, but, in most cases, the reality is starkest for black women.
Social and personal circumstances also influence these disparities. Black and Hispanic women facing breast cancer are less likely than white women to be married, suggesting that they may not have the same at-home support, not to mention the financial cushion of being able to rely on a working spouse for income or an extra set of hands for child care during treatment. And within the black community, breast cancer long held a damaging stigma that left many with the diagnosis feeling isolated and unsupported-and that may have even deterred women from seeking routine screenings. Rising screening rates among black women suggest that trend may thankfully be reversing-and in fact could be behind the recent rise in breast cancer diagnoses among black women-but remnants of that stigma and fear undoubtedly add undue emotional stress as black women face cancer.
A cancer diagnosis is difficult for anyone to hear, but it’s also difficult to hear and confront the reality of breast cancer for women of color, a reality often hidden behind the pink ribbons and overhyped marketing.
One week after my wife’s treatment began, it’s hard to say that we feel lucky, knowing the long road we have ahead. But it’s impossible to deny that we are indeed lucky, by virtue of the privilege we carry in this world. And that privilege-or lack thereof-should never be the life or death determinant for any woman.