Myth that disease affects white people still persists
Awareness drive for breast cancer leaves rural women out
It is Breast Cancer Awareness Month, and questions around its reach are important to ponder. Who is the awareness really for?
Much of the awareness is predominately in English, while cancer centres are mostly in urban areas. The result – women in rural areas struggle to receive and understand the life-saving messages.
Accessibility remains a huge challenge to both diagnosis and treatment. Once diagnosed, black women must contend with many other socioeconomic challenges that limit receiving treatment, even if it is free at public health-care institutions.
Women in the Northern Cape and parts of North West, for example, have to travel to Kimberley to access treatment. Kuruman has a satellite facility, but with limited resources and staff. Most poor rural black women cannot afford travelling to Kimberley because of extreme poverty.
A 2019 study by the Pietermaritzburg Economic Justice and Dignity Group shows that 55.5% of the population survives on R40.90 per person per day. SA is also the most unequal society in the world, with black women making up an overwhelming number of the poor and marginalised. When they are diagnosed with breast cancer, they have the burden of having to pit bread-and-butter issues against their concerns.
Breast cancer awareness and education needs to be scaled up in the black communities to also consider these socioeconomic limitations. Greater focus on primary healthcare is also needed for speedy referral for screening and diagnostic tests. These interventions are still largely lacking, partly because of the myths around who is affected by cancer. The misconception that cancer is a disease that only affects white people still persists despite the growing incidences among black women. One reason influencing this racialised idea of the illness might be that there are seemingly higher incidences of breast cancer among white women.
In 2011, the National Cancer Registry reported that the overall risk for breast cancer in SA is one in 29 women, and further estimated that the lifetime risk is one in 12 among white women and one in 50 among black women. These figures, however, do not account for the black women who might never receive a proper diagnosis. Current and accurate research is not available on how these figures might have changed over the past 10 years.
The 2017 Breast Cancer Prevention and Control Policy, however, attributes lower incidence of breast cancer among black women to multiple socio-cultural factors, such as universal and prolonged lactation, low use of hormone replacement therapy, late menarche, early age of first birth, and a diet low in fat and high in fibre. However, due to rapid urbanisation and lifestyle changes, there has been a significant decrease in these protective factors, making black women vulnerable to increased incidences of breast cancer and mortality.
Historically, cancer, along with other non-communicable diseases, have been understood as diseases of affluence, related to economic development, consumption, and lifestyle. In contrast, infectious or communicable diseases were understood as diseases of poverty and impoverishment. These crude categorisations were central in explaining global health inequalities, but the epidemiological transitions of the past few decades have forced us to think more critically.
In SA, breast cancer has been declared a national priority, as highlighted by the Breast Cancer Prevention and Control Policy which notes that women who live in rural areas are at a disadvantage regarding access to information and services; however, little is said about the intersections of race, class, and gender in understanding the structural barriers to breast cancer awareness and knowledge. Poor or inadequate awareness and knowledge among black women should be a call for concern.
This leads to delayed detection, presentation, diagnosis, and treatment. This results in a late stage of cancer upon diagnosis, aggressive treatment, severe side effects, poor quality of life, or worse – mortality. As public health specialists often say, "equity in healthcare begins with equity in health education".
It is important to note that some women have exercised their agency to advance breast cancer awareness. Mama Lillian Dube, for example, used her public platform to talk about her experience, demystifying the illness and advocating for quality healthcare services for women.
Community healthcare workers have done great work in the past to create awareness around HIV/Aids. Similar strategies should be considered for breast cancer to ensure that no woman is left behind.
• Shange is a lecturer in the department of sociology at the University of the Free State, while Lesego Bertha Kgatitswe is a lecturer in the department of sociology at Sol Plaatje University .
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