With October behind us, so too is the frenzy around the pink ribbon—the symbol of our nationwide campaign against breast cancer. Despite month-long displays of solidarity, many awareness campaigns have turned a blind eye to perennial disparities in care. In a country where marginalized women are more likely to die from breast cancer, our efforts to curb the disease require constructive policies that work to dismantle inequities within our health systems—not pink-washed products.
One such product hit the shelves last year when oil behemoth Baker Hughes—which specializes in hydraulic fracturing, or “fracking”—joined forces with breast cancer foundation Susan G. Komen to produce pink drill bits. Fracking, a procedure by which oil is extracted from the ground, is highly toxic. More than a quarter of the chemicals used are known carcinogens, and some are linked to breast cancer. On top of that, fracking is more likely to occur in impoverished areas, where medical care—let alone care for breast cancer—is already difficult to come by.
A few years prior, Susan G. Komen teamed up with an unlikely ally: Kentucky Fried Chicken. The fast-food chain packaged its signature dish in pink and pledged a donation to its partner for each “Bucket for the Cure” sold. The campaign stirred a fair deal of controversy—and rightly so, as fried meats are associated with breast cancer. In addition, the campaign marketed its product—with all of its adverse health implications—primarily to the poor in a dubious effort to access hard-to-reach populations. The fast-food chain is found largely in low-income neighborhoods, where healthier food options are often out of reach for most residents.
To be sure, not all campaigns against breast cancer have raised so many eyebrows. Some 67 percent of women at high-risk ages have received mammograms within the past two years, a statistic that, while far from perfect, attests to the success of many awareness campaigns. Billions of dollars are poured into breast cancer research annually, which is surely another part of the reason that breast cancer patients now enjoy a five-year survival rate of close to 90 percent, up from about 75 percent in 1980.
But a closer examination of the numbers reveals a much more grim reality. Gains from the war on breast cancer have by and large sidestepped women of color and low-income women, and instead have accrued largely to more privileged patients. Prior to 1980, such shameful disparities did not exist. Black women and white women faced nearly identical mortality rates of about 33 deaths per 100,000. But today, black women are most likely to die from the disease. Researchers say that biological differences do not account for differences in survival.
A 2015 study found that black women were between 40 and 70 percent more likely to have a late diagnosis, when they are already in the advanced stages of breast cancer. Hispanic women were 30 to 40 percent more likely to be diagnosed in advanced stages. Late detection, of course, so often translates to higher costs of care and lower survival rates.
Race even impacts the quality of treatment that breast cancer patients receive. The same 2015 study concluded that black women were between 30 and 60 percent more likely than white women to undergo inappropriate treatment for the disease, and Hispanic women were 20 to 40 percent more likely.
Research cannot fully explain these disparities, but poverty is a clear factor, facilitated by woeful public policies and institutionalized racism. Women in low-wage jobs without paid sick leave—disproportionately women of color—are less likely to receive the preventive care necessary to detect breast cancer in its early stages. As a result, these women are more likely to die from the disease. One study found that, while 63 percent of women with paid sick leave had received a mammogram within the past year, only 52 percent of women without paid sick leave had gotten one. And it makes sense. The 40 million workers who toil without paid sick leave risk reductions in precious income or even the job itself for time away. Preventive care cannot be a luxury only afforded to those in comfortable jobs.
While breast cancer has no cure just yet, solutions to health disparities like these do exist. Paid sick leave is among them. Clinics funded through Title X—the federal grant program that is constantly under threat—offer mammograms to low-income women and serve as a lifeline for those otherwise on the margins of care. Medicaid, too, has proven an invaluable source to those in poverty, but 19 states have refused to expand the insurance program under the Affordable Care Act. This policy choice has dire consequences. It is in some of these states—like Alabama, Kansas, and Oklahoma—where women are most likely to die from breast cancer.
When black patients die from breast cancer three years before white patients, and low-income women face impossible choices between the care they need to survive and their livelihoods, we need to embrace policies—not pink drill bits—to curb our unjust health disparities.