Overview
Breast cancer accounts for nearly one in three cancers diagnosed among U.S. women and is the second leading cause of cancer death (DeSantis 2015). It is classified into four stages to indicate the extent of the cancer (American Cancer Society 2016). Although cancer survival rates cannot accurately determine each patient’s future, these statistics can help provide a better understanding of the disease. The 5-year relative survival rate, or the rate at which women with breast cancer are likely to survive in comparison to women in the overall population, is close to 100 percent for women with stage 0 or stage I breast cancer (American Cancer Society). The survival rates begin to decline, however, as the stages progress. The 5-year relative survival rate for women with stage II breast cancer is about 93 percent while stage III is approximately 72% (American Cancer Society 2016). Stage IV, or metastatic, breast cancer is cancer that has spread elsewhere in the body and has a 5-year relative survival rate of about 22 percent (American Cancer Society 2016).
Further statistics show that, historically, white women have had higher rates of breast cancer when compared to African-American women, but in 2012, the rates converged (DeSantis 2015). African-American and white women have increased chances of breast cancer when compared to other races due to their likelihood to put off childbirth and likelihood to have fewer children, both of which are known risk factors for breast cancer (Susan G. Komen 2017). Oncologists Daly and Olopade emphasize that although white women still have a slightly higher rate of being diagnosed, African-American women are more likely to die from breast cancer (2015). This disparity between African-American and white women has continued to widen, and death rates were 42 percent higher in African-American women than in white women by 2012 (DeSantis 2015). Daly and Olopade further highlight the reasons for the disparities and cite tumor biology, genomics, and patterns of care as playing a role in the high mortality rate among African-American women (2015). African-American women are more likely to be diagnosed with triple-negative breast cancer, meaning they lack the receptors most successful treatment options target (Daly and Olopade 2015). Studies have also shown that African-American women have more grade III tumors than white women and are more likely to have tumors that present with necrosis (Daly and Olopade 2015). Compared to other races, African-American women are more likely to be found with BRCA 1 and BRCA 2 mutations, the inherited gene mutations that increase chances of breast cancer (Daly and Olopade 2015). In addition to biological and genetic differences, African-American women also see variations in quality of screening and treatment as well as delays in, misuse of, and underuse of treatments (Daly and Olopade 2015).
“One less” statistic
Breast cancer statistics have been used heavily throughout awareness campaigns in order to further fundraising efforts, build a network of support groups, and further research. The idea of surviving against the odds offers a hint of hope for patients who are in an otherwise uncertain position. Statistics are also utilized heavily by the media to encourage people to be proactive about screenings and to not be included in the numbers who are affected by cancer (Jain 2011). One example is the advertising campaign for Gardasil, which encouraged its audiences to become “one less” statistic by taking the vaccination (Jain 2011).
The widely publicized numbers and statistics, however, have become the source of controversy and criticism, as they have created significant amounts of fear around cancer. One study found in a group of “’2,500 girls aged 8-18, nearly 30% believed they might currently have breast cancer’” (Jain 2011, S53). In addition to the fear of potentially developing cancer, statistics about survival rates may cause frustration for existing patients. As highlighted by medical anthropologist Lochlann Jain, “you don’t 70% die; you live or die” (Jain 2011, S47). Statistics and percentages can be utilized by both doctors and patients as guidelines for prognosis, but when considering a patient’s personal battle with cancer, numbers are not likely to narrate the whole story. Factors such as race and socioeconomic status that may contribute to an individual’s personal cancer narrative are difficult to account for in these published statistics.
In order to combat these disparities as well as protect vulnerable populations and improve the quality of care delivered to minorities, Daly and Olopade conclude that delivery system reform may offer a solution (2015). Although African-American women face biological and genetic disadvantages, the quality of care and the amount of support received have the potential to improve mortality rates for the population (Daly and Olopade 2015). Additionally, better quality of care is arguably even more important due to these biological and genetic disadvantages African-American women face. Daly and Olopade’s recommendation to begin delivery system reform reinforces the idea that while biological and genetic statistics play a factor in determining prognoses, quality and delivery of care is where much of the disparity lies as well.
An advertising campaign for Susan G. Komen® San Diego calls for action, urging people to register for the Race for the Cure. The ad also stresses that the organization is not political and is dedicated to directly helping breast cancer patients as well as funding research. (Cool Grey Matter).
Politics of Health
Breast cancer relates to the politics of health because it connects to biological citizenship and racialization. Biological citizenship was originally defined by “a demand for, but limited access to, a form of social welfare based on medical, scientific, and legal criteria that recognize injury and compensate for it” (Petryna 2004, 261). According to sociologist Torsten Heinemann, biomedical information also “opens up new opportunities for collectivization and biosociality and subsequently allows for collectively claiming rights, access to social welfare, and other forms of public support” (2016, 347). Heinemann thus ties biological citizenship to the formation of “patients’ associations, disease advocacy organizations, and self-help groups” that allow for greater public engagement (2016, 348). One of the most widely recognized advocacy organizations that supports breast cancer is the Susan G. Komen Foundation. Through highly publicized advertising campaigns supporting the “pink” movement, Race for the Cure, and with the support of numerous corporate sponsors, The Komen Foundation has established a powerful network with one shared goal: reduce the current number of breast cancer deaths by 50 percent in the U.S. by 2026 (Susan G. Komen 2017). Through this powerful network, the Foundation has been able to reach a large population and exert political influence. Numerous survivors and their supporters have also found a community within Susan G. Komen, and by donating or participating in their sponsored runs, participants become a part of this community. In his piece on biological citizenship, Heinemann highlights how in Petryna’s example of Chernobyl, survivors “became active in self-help organizations and advocacy groups in order to influence political decisions” (2016, 349). Based on the medical conditions they had in common post-Chernobyl, survivors were able to form a community to fight for shared goals of access to healthcare and social welfare (Heinemann 2016). Similarly, based on a common diagnosis of breast cancer, survivors connect through the Susan G. Komen Foundation to fight for a cure.
One criticism of biological citizenship, however, is that it harbors the “potential for exclusion and restriction of citizenship rights based on biological traits” (Heinemann 2016, 348). Komen has been criticized for not addressing the racial disparities present in breast cancer mortality rates, but these disparities reinforce that social factors are significant, whether they are “white, black, brown; single, partnered, married; low income, heirs; immigrants; handsome, intimidating, tubby” (Jain 2013, 223). Beyond the statistics are human beings and as Jain concludes in their ethnography, Malignant, “where we are located in these social structures matters to our experiences with cancer, to our survival chances, and to the ways we are treated” (Jain 2013, 223).
Jain’s statement ties into the racial disparities seen in women diagnosed with breast cancer, and can be considered to examine how breast cancer relates to racialization. The higher mortality rate for African-American women compared to white women can be attributed to the concept of racialization. Medical anthropologist Wolf-Meyer argues that there is an “implicit whiteness embedded in medicine and social norms” (2015, 456). This is seen in breast cancer with the consistent incidence rates for both African-American and white women but higher mortality rates in the African-American population. As Daly and Olopade point out, these high mortality rates can be addressed and improved with better quality of care and closer attention to the biological and genetic variances (2015). The comparatively higher mortality rate for African-American women suggests a standard of care among breast cancer treatment that does not fully address these biological and genetic differences, thus reinforcing Wolf-Meyer’s argument of an “expectation of orderly bodies- of ‘white’ bodies that exemplify social and cultural norms of biology and behavior” (2015, 446). Beyond the ubiquitous statistics lie social and economic health disparities that numbers cannot reveal at first glance, but understanding these disparities is essential in better combatting breast cancer overall.
Participants in the Susan G. Komen Race for the Cure. Komen St. Louis/Facebook
-Snigdha Udupi
References
American Cancer Society. “Breast Cancer Survival Rates.” Last modified August 18, 2016. Accessed September 23, 2017. https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html#written_by
Daly, B. and Olufunmilayo I. Olopade. “A perfect storm: How tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change.” CA: A Cancer Journal for Clinicians, 65 (2015): 221-238, doi: 10.3322/caac.21271. Accessed October 14, 2017. http://onlinelibrary.wiley.com/doi/10.3322/caac.21271/full
DeSantis, C. E., Stacey A. Fedewa, Ann Goding Sauer, Joan L. Kramer, Robert A. Smith, and Ahmedin Jemal. “Breast cancer statistics, 2015: Convergence of incidence rates between black and white women.” CA: A Cancer Journal for Clinicians, 66 (2015): 31–42. Accessed September 24, 2017. http://onlinelibrary.wiley.com/doi/10.3322/caac.21320/full
Heinemann, Torsten. “Biological Citizenship.” Encyclopedia of Global Bioethics (2016): 347-353. Accessed September 24, 2017. https://link.springer.com/referenceworkentry/10.1007%2F978-3-319-09483-0_453
Jain, Sarah S. Lochlann. Malignant: how cancer becomes us. Berkeley: University of California Press, 2013. Accessed September 23, 2017. http://ebookcentral.proquest.com/lib/Vand/reader.action?docID=1323166
Jain, Sarah S. Lochlann. “Survival Odds: Mortality in Corporate Time.” Current Anthropology, 52 (2011): S45-S55. Accessed September 23, 2017.
Petryna, Adriana. “Biological Citizenship: The Science and Politics of Chernobyl-Exposed Populations.” Osiris, 2nd Series, 19 (2004): 250-65. Accessed September 24, 2017. http://www.jstor.org/stable/3655243.
Susan G. Komen Foundation. “Our Bold Goal.” Accessed September 23, 2017. http://ww5.komen.org/ourboldgoal/?utm_source=Komen.org&utm_medium=GlobalHeaderCTA&utm_campaign=MoreThanPink
Susan G. Komen Foundation. “Race and Ethnicity.” Accessed October 14, 2017. https://ww5.komen.org/BreastCancer/RaceampEthnicity.html
Wolf-Meyer, Mattthew. “Biomedicine, the whiteness of sleep, and the wages of spatiotemporal normativity in the United States.” American Ethnologist, 42 (2015): 446-458, doi: 10.1111/amet.12140. Accessed October 15, 2017. http://onlinelibrary.wiley.com/doi/10.1111/amet.12140/full
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