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After being diagnosed with breast cancer, many black women face delays in their care

Tamiko Byrd was only 43 years old when she was diagnosed with stage 4 breast cancer in October 2015.

The diagnosis rocked Byrd, who spent years as a fitness trainer and health educator in underserved Black communities, towards her core. The same goes for cancer treatment. Byrd recently moved to Houston to graduate school, has children in care and also needs to continue her job as a Xerox technician, which provides her health insurance.

“I was petrified,” said Byrd, the Negro. “I was in a new city. I have no savings. I wonder how can I buy it? How will I take care of my baby? How will I live? Will I live? “


Within two weeks of being diagnosed, Byrd started chemotherapy sessions, leaving her extremely weak, tired, and sick. Although she may still be on leave to complete her treatment, her car was recalled, meaning she had to ride the bus for 25 minutes instead of driving 1

0 minutes to get to chemotherapy sessions. . After a long course of treatment, doctors declared her cured in December 2016.

But Byrd was still unable to return to work – and eventually lost his job and health insurance in January of that year. “I just couldn’t do it,” said Byrd. “I have no power.” Byrd, who at the time was mainly living on student loans, missed out on a year of medical appointments until she qualified for Medicaid in 2018.


According to experts, her experience reflects the challenges many black women face after being diagnosed with breast cancer in the US. A recent analysis found that some barriers to health care meant that many black women postpone treatment after being diagnosed with breast cancer, and also have an average long treatment duration. than white women. That could have far-reaching – and devastating – consequences.

Melissa Troester, professor of epidemiology at the University of North Carolina at Chapel Hill and co-author of the new study, said: “If it takes longer to get treated, that could delay people in bringing their lives are back on track and moving forward. “These differences have profound effects on life.”

There is a lot of research showing that black women are more likely to die from breast cancer than other groups, although the incidence is generally similar. To find out the health care-related potential causes of that discrepancy, Troester and her colleagues evaluated the care process of 2,841 black and white breast cancer patients in North Carolina. . They found that although low socioeconomic status was associated with a delay in treatment in white women, treatment delays were high at all levels of socioeconomic status in white women. black women.

Research has pointed to three specific problems associated with prolonged breast cancer treatment: lack of insurance, challenges of transportation and financial stress, which are attributable to rich disparities, experts say. poverty among black and white families in America.

“We know cancer undermines well-resourced people,” said Oluwadamilola Fayanju, an assistant professor of surgery and population health science at Duke University of Medicine. “Given that gap between rich and poor, there is no way [Black] people can recover financially from cancer treatment. “

Financial stress can also be exacerbated when the patient is uninsured or uninsured; According to a recent US Census Bureau report, an estimated 10% of blacks in the US are uninsured, compared with 5% of whites. And even if people are fully insured, “the copay that patients have to pay is huge,” says Fayanju.

Even going to the hospital or clinic on your own for radiation therapy, chemotherapy, or regular checkups can be a challenge for some patients. For those who depend on public transport or in rural areas, access to public transport or the cost of filling a gas tank can interfere with cancer care.

The same is true for parking lots, which can add a financial burden to an already expensive care process. An article published in July in the journal JAMA Oncology says parking fees can range from $ 2 to $ 5 per hour and $ 5 to $ 10 per day at 63 cancer treatment centers in the US, up to $ 800 for a patient being treated for breast cancer. The parking fee is one of the reasons Byrd opted for public transportation rather than driving himself to cancer appointments.

Recognizing these challenges, some health care providers work on schedules to pack appointments within a day, rather than leaving them for the patient.

“But our conception of what is convenient and inconvenient for the patient may not really reflect reality,” Fayanju said. For example, if a patient had to consult with a surgical oncologist, radiologist and oncologist on the same day, then that could mean three copayments, even if the oncologists are affiliated with the same clinic. “[Patients] might actually prefer allocating the cost of the copayments over the course of a few days or weeks and coordinating it with when they get paid next. “

Transportation can pose an even greater challenge when health care facilities are far away, which can also disproportionately affect Blacks in some communities.

“There is a history of red line classification and how neighborhoods were designed in times of discrete and when integration occurred, [health care] Christina Yongue, an associate professor of public health education at the University of North Carolina in Greensboro, said.

Altogether, those challenges, among others, pose significant obstacles for some Black women as they seek treatment after being diagnosed with breast cancer.

Karen Jackson, founder and CEO of Sisters Network said: “When you don’t have the right income, or the right knowledge, or access proper, your tumor biology is a challenges, it all adds up to a bad job. an African-American breast cancer survivor.

Going forward, Yongue said she wants to see racism, not just race, which is analyzed and calculated in studies that evaluate disparities in health care as seen in the study. new rescue.

“You can measure tacit bias among health care providers, gatekeepers ‘breach, and look at hospitals’ mission statements to see if they’re making an effort,” she said. power to resolve the issue of race equality or not. “I see the emergence of racism when people are too focused on the health care activities of colorblind people. It is ignoring the patient’s entire identity, ”she said.

Back in 2015, after being diagnosed, Byrd said she had been tasked by a social worker tasked with helping her fill out forms and navigate her racial prejudice schedule. It is assumed that Byrd may not be able to get to appointments on time or have the transportation needed to do so.

“At that moment, you wondered if I was white, would it come down like this,” she said. “You have these flashing flashes saying, if I were a blonde, blue-eyed woman here, divorced, breastfeeding, I would get more and more sympathy, ‘What can I do to help you?’

Researchers such as Troester agree that individual patient perspectives will be important to better understand the many factors that affect treatment delays and long-term care processes in black women with cancer. breast letter. In the future, her team hopes to collect data on patient experiences as they navigate the healthcare system.

“We’ve known about this disparity for three decades and we can’t close it,” she said. “I wish we could go further in dealing with them.”

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