By Nyala Thompson Grunwald
Women account for 14% – 30% of breast cancer deaths in the Caribbean. For the purposes of this article, when I use the word ‘woman/women’ I am referring to female assigned at birth, trans women. And while the research used for this blog post is mainly directed at the socioeconomic implications of breast cancer in women, it is noteworthy that any person regardless of self, can develop breast cancer. The awareness regarding the physicalities of breast cancer affect us all, it is the social, economic, political…intersectional ramifications that can differ.
Now hol’ up on that first statistic. Think of your tanties, your mamy, the members of your family (chosen, not chosen, up to you) and women in your surroundings. And think that each of them are at risk of being diagnosed with breast cancer.
Now, at the time of writing, I am a 22 year old cisgender woman who, whilst having an awareness of the existence of the breast cancer illness through experience or information, have not been actively educated about what the actual condition is. Nor have I actually sought out this information either, you’ll tell me, yet that in itself is part of the problem. If, at every stage of your social education and development, you are taught within the frames of white cisgender male heteronormativity, these implement gaps in your learning that require progressive dismantling – with no small amount of effort. Health issues and how they affect women, non-white women are such a gap.
This month is breast cancer awareness month, part of an international campaign to promote awareness about the illness. Medical sources will indicate that breast cancer is a malignant tumor that starts in the cells of the breast, affecting any person (Caribbean Public Health Agency, 2018). Depending on several genetic and non-genetic factors, patients can recover – or not! – through relevant treatment. What causes breast cancer?
Surprisingly, across all the academic and medical sources I read, and those that I used for this article (listed below), I was unable to pinpoint a clear cause for how this condition develops, only elements that can increase the risk of being diagnosed with it. Of the sources I used, the consensus lists that age, genetic family history, previous diagnoses of benevolent or malignant conditions, excessive alcohol use, and obesity are the primary causes involved for the physical development of breast cancer (CARPHA 2018, Winters et al 2017).
Significantly, I use the phrase ‘physical development of breast cancer’. Certainly, the causes listed above are only part of the reasons for the potential development of breast cancer in women, indeed in any person. They are the physical factors. Socioeconomic factors are perhaps the most important to take into consideration in raising awareness about breast cancer, for those factors can be collectively addressed. Dr Virginia Asin-Oostburg, director of CARPHA in 2018, states that breast cancer “can be prevented through education, screening, early detection, diagnosis and treatment” (CARPHA 2018). These are solutions to socioeconomic factors.
A study led by the Pan-American Health Organisation (PAHO, 2016) states that the annual rate of breast cancer diagnoses are 90/100,000 women in Europe, as opposed to 30/100,000 women in West Africa. Of the latter statistic, the death rate is listed as 15/100,000 women per year (ibid). There are two things about this statistical information: one is that the statistics about the West African region are just that, indicative of a region in an immense continent, as opposed to statistics that account for an entire continent. Second, which the PAHO study points out when discussing reports and statistical information in the Caribbean region, is that it is uncertain exactly how these statistics are calculated (PAHO, 2016). That is telling of the disparity in resources which affects the respective capacity to address medical treatment in cancer and breast health .
More specific to the Caribbean, the PAHO study posits that statistically, the rate of diagnoses of breast cancer of women per year are placed between the Europe/West Africa frame of reference. One of their arguments for this placement is that “epidemiologically the Caribbean is in the middle of a transformation from third World to first World fertility patterns”, patterns such as higher ages of a person’s first pregnancy, the decrease of the number of children/women ratio…etc that affect breast cancer rates in the region. Setting aside the use of ‘third Word/first World’ terminology that enters into Western and Eurocentric raciological discourse, this testifies to the potential of changing social patterns that can increase or decrease breast cancer rates.
Similarly, the PAHO study demonstrates that 86% of women in the Caribbean who have a breast cancer diagnosis detect the condition themselves. Moreover, an analysis of reports made in the Caribbean relating to breast cancer condition and treatment state that “it is then plausible that Caribbean women with private insurance and higher socioeconomic status may have better access to mammography” (Ragin et al, 2018). Separately, this information can be considered as stand-alone. However, put these together to consider the overall picture and several things become clear: socioeconomic factors of education, healthcare access – in all the financial, spatial…etc senses of the term – income, among others, account for the lack of awareness about breast cancer. Stemming from a lack of awareness is a lack of active participation in checking yourself, checking in with others in your women – network, communicating with the medical services available to you about your breast health.
Across all the sources utilised in this article, and the ones read, there is a unanimous consensus that early diagnosis increases the chances of recovery from breast cancer (CARPHA, PAHO, Winters et al, Ragin et al). Yet this instruction enters the issue discussed in the Ragin et al study considering reports about breast cancer health in the Caribbean from 1975 to 2017. This study concluded that the reports considered were descriptive of breast cancer and breast health. Indeed, such indications are wholly insufficient to address the collective issue of misinformation, late diagnosis, poor prognosis, miseducation and ultimately devastating rates of an oft terminal illness.
Medical and socioeconomic policy relating to breast health and breast cancer needs to be prescriptive and preventative rather than descriptive.
The PAHO study proposes implementing tumor registrars in clinical services to account for breast cancer rates, as well as shifting the lens of breast treatment from before potential diagnosis (PAHO, 2016). The study also suggests re-educating women from an early age on how to check their breasts on a daily basis, developing inexpensive self tests (for instance to check for HPV infections) and training all medical staff – regardless of specialisation – in cancer care (ibid). Ragin et al also suggest developing a regional strategy that would collectively address this issue in the Caribbean (Ragin et al, 2017). These policies, if adopted and implemented widely and efficiently, would indeed turn the tables on breast health and breast cancer diagnosis and treatment in the region.
So what’s prescribed for this month? We all educate ourselves more on breast cancer and our breast health. Learn how to check-in with our bodies, spread awareness and encourage discussion so this information is not simply addressed to one part of the human population. If you’re involved in professional medical and political, socioeconomic environments? Use your platform to promote change in policies and approaches to breast cancer. Encourage and engage in a collective dialectic that addresses and acts on breast health.
Deutsch Madeline B, ‘Screening for Breast Cancer in Transgender Women’, University of California San Francisco 17/06/2018, https://transcare.ucsf.edu/guidelines/breast-cancer-women
Garcia Gabriel, ‘Breast Cancer: Number 1 Killer among Females in the Caribbean’, Caribbean Public Health Agency 22/10/2018, https://carpha.org/More/Media/Articles/ArticleID/231/Breast-Cancer-the-No-1-Killer-Among-Females-in-the-Caribbean
Hurley Judith, ‘Breast Cancer in Caribbean Women’, Pan-American Health Organisation, 2016
Ragin Camille et al, ‘Breast Cancer Research in the Caribbean: Analysis of Reports from 1975 to 2017’, Journal of Global Oncology vol.3, American Society of Clinical Oncology 2018, pp.1-21
Winters Stella et al, ‘Breast Cancer Epidemiology, Prevention and Screening’, Progress in Molecular Biology and Translational Science vol.151, Elsevier Inc 2017, pp.1-32
Nyala Thompson Grunwald (she/her) is a Franco-Trinbagonian pannist, artivist with two bachelor’s in arts. Currently a postgraduate student based in London, Nyala’s research thus far focuses on decoloniality, and afrodiaspora in race, music, gender and culture.