Challenges Facing African-American Women with Breast Cancer, Assessment Example

Introduction

Breast cancer is an illness that is a challenge for anyone who receives that diagnosis. According to the World Health Organization (2009), breast cancer is the leading cancer killer among women 20 to 59 years of age in high-income countries” (Phillips & Cohen, 2011).  Unfortunately for African-American women, it is a particularly bleak pronouncement because of the high rate of mortality. The chances for this population to be diagnosed and eventually to die from this type of cancer is greater than that of any other ethnic group in the U.S. Various studies tried to explain this phenomenon, and suggested that the reasons for the high mortality rate among African-American females diagnosed with breast cancer might rest on poor access to health care, fatalistic attitudes about treatment, suspicion and fears about the medical community’s treatment, as well as spiritual and religious beliefs that put more faith in God (Phillips & Cohen, 2011; Gullatte, et-al, (2010); Masi & Gehlert (2009); Peek, Sayad & Markwardt, (2008). From a biological perspective, social and psychological problems are viewed within a disease framework; evidently, a close relationship exists between the physical, the psychological and the external environmental health of individuals (Dziegielewski, 1998).  This paper will discuss the bio-psycho-social tasks facing African American women who have been impacted by a diagnosis of breast cancer.

Description of the Illness:

Cancer, as defined by Beder (2006), is “a cell in the body [that] mutates to an abnormal state and begins to multiply uncontrollably” (p. 81). In other words, the cancer occurs because changes in the genes control the growth of the cells as well as maintaining their health.  The genes are located in the nucleus of each cell and performing as a “control room” (BreastCancer.org, 2012.)  In general, new, healthy cells replace old ones as they die. Over time, however, changes can activate some genes and deactivate others within a cell. This alters has the ability to divide continually, without any order, creating more of the same type of cells and resulting in the formation of a tumor.  Tumors can be either benign or malignant. Benign tumors are not considered to be harmful nor cancerous. Their growth rate is slow, and they do not spread to other tissues in the body.  Conversely, malignant tumors are dangerous and when left untreated they can quickly spread to another body part.

Similarly, breast cancer is a procedure by which the malignant tumor develops from the breast cells.  In many cases, breast cancer commences in the lobule cell; the one that facilitates the production of milk in a woman’s breast. It may also begin in the ducts, which are the passage through which milk is drained to a woman’s nipple from the lobule. In rare cases, breast cancer will begin at the stromal tissues, which are made up of the fibrous, fatty breast tissues (BreastCancer.org, 2012.)  Additionally, in most cases, breast cancer is caused by a genetic abnormality, and only 5 to 10% cases occur because of an abnormality that is inherited.  Lastly, statistics show that 90% of the disease are caused by genetic abnormalities, which occur as a result of aging and the overall rigors of life (BreastCancer.org, 2012.)

Unfortunately, breast cancer is considered to be the second most common cause of death in the United States.  According to the U.S. Breast Cancer Statistics (2012), about one in eight women, or just fewer than 12%, will develop breast cancer over the course of her life. As mentioned before, it greatly affects African American women with a mortality rate of 32.8 deaths per 100,000 as opposed to that of white women with a mortality rate of 23.3/100,000. “This disparity is especially apparent in Chicago, where the African-American/white breast cancer mortality ratio increased from 1.27 in 1990 to 1.68 in 2003” (Masi & Gehlert, 2008, p, 408).  In addition, a delay in the breast cancer detection is a dangerous factor since the disease has to be diagnosed at its critical stages. Researchers have found that a delay of three months or more of seeking medical care has an extremely high risk of increasing mortality. According to the American Cancer Society (ACS) the age of 40 and older is the average age that requires women to conduct mammography screening (Phillips & Cohen, 2011). However, due to many reasons African-American female do not seek the accurate medical attention which is necessary to detect the disease at its early stage.

Life Event Affect on the Patient

Generally, women with a personal history experience the diagnosis as a life altering event in many different areas: occupational, social and familial, achievement of personal goals, and family relationships (Phillips & Cohen, 2011). For some women, relationships become stronger while for others, their connections with others are disappointing or less supportive than desired.  Many women with breast cancer have reported that their spouses attended doctors’ appointments and laboratory tests with them.  In addition, for women with children there is a tremendous need expressed to see their children grow up as well as making sure that their children are educated about the family history of breast cancer.  Another significant issue is access to healthcare and barriers to such care.  The cost of treatment for breast cancer is extremely expensive, and uninsured women are simply unable to receive the type or level of care that is needed. Even with insurance, many women simply cannot afford to see physicians and to receive the type of treatment that would be ideal for their conditions. Lastly, many women experience insensitivity by their healthcare providers, who they experienced as minimizing the risks of their disease as well as the emotional toll it takes on them and their families (Phillips & Cohen, 2011).

Literature reviews suggest several factors that prevent African-American women from seeking help. Peek, Sayad, and Markwardt (2008) studied the factors that might cause fear of breast cancer screening among African-American female. The researchers examined 29 low-income women from urban communities in Chicago, and their finding pointed out “psychological barriers to mammogram utilization, including negative health care experience, fear of the health care system, denial and repression, psychosocial issues, delays in seeking health care, poor health outcomes and fatalism” (p. 1847). In most cases, fears of mammograms were caused by a lack of accurate information about the test, as well as deficient communication about the test by patients and their physicians. These implications can help healthcare providers such as physicians, nurses, social workers, and psychologists, to communicate better and reinforce fears about breast cancer screening.

Furthermore, feelings of disrespect, mistrust, and unequal treatment have been expressed by low income African-American women in the United States. Unfortunately, there is a long history of unethical experimentation and substandard medical treatment such as the Tuskegee experiment, which has resulted in a mistrust of physicians and healthcare organizations among the African-American community (Peek, Sayad, & Markwardt, 2008).  Therefore, many African- American females lack confidence in diagnostic testing and results, which causes them to simply avoid seeking the kind of screenings that would help in early detection, treatment and cure of breast cancer. In situations where African-American women have been treated by culturally sensitive healthcare providers, there has been an increased tendency to seek mammograms because the patient-physician relationship was better and characterized by more trust. Some of the worries connected with breast cancer screening involve the mammogram process itself. These fears could be minimized by improving the quality of breast cancer screening available, ensuring that patients are not kept in the waiting room for a long period of time during the mammogram procedure, modernizing radiology equipment, training and improving personnel, and educating radiology technicians on how to help patients through the mammogram process. (Peek, Sayad, & Markwardt, 2008).

Another study sought to understand “the perceptions of breast cancer treatment among African-American women and men” (Masi & Gehlert, 2008, p.408).  The methodology involved preparing a questionnaire, which was administered to a number of 280 females and 165 males “who live in one of 15 contiguous neighborhoods on Chicago’s South side” (p. 408). The results indicate that mistrust of medical organizations, as well as the federal government, race, health insurance, intimate relationships, and perceptions of treatment are the main factors that keep this population from conducting checkups to prevent the onset of breast cancer.  In addition, the women are hesitant about seeking breast cancer treatment because of the effect following surgery, radiation, and chemotherapy procedures.

Gullatte, et-at (2011) found out that religiosity, spirituality, and fatalistic beliefs about cancer play an important role in African-American women’s decision making regarding healthcare. This population believes that illness is an intrinsic part of the world created by God. Therefore, “the superiority of spiritual or religious intervention by a higher power through prayer” (Gullatte et-al, 2009, p, 64) is preferred over the use of medical intervention. In addition, the researchers found that the majority of participants who had fatalistic views of cancer were less educated, older than 50 years of age, and had lower socioeconomic status (Gullatte, et-al, 2010).

Lastly, Phillips and Cohen (2011) studied the correlation between the medical health experience among African-American women and the high risk of being affected to the disease. After interviewing a sample of 20 females with a family or a personal history of breast cancer, the researchers identified five subjects that increase the risk for African-American female to delay the tests for cancer detection. According to their findings, they concluded that “young women at high risk for breast cancer have unique emotional and support needs that are shaped by stage in life, relationships with significant others, their faith, and interactions with the healthcare delivery system” (p.239).

Life Event Affect on the Family/Caregiver

When dealing with breast cancer, all the attention is directed, generally, to the patient and the difficulties she or he is faced with. However, the partner, or the caregiver, also faces many difficulties and needs no less a sympathetic ear and help. The systems perspective suggests that a human being is not a separate unit, but rather, part of a family and social system that is affected by intergenerational relations. Therefore, when one family member is affected by an illness and is suffering from it, there is an influence on the other members of the family, especially the caregiver. Unfortunately, these days there are very few studies that have been done on the impact of the illness and its treatment on the spouses. However, a few literature reviews show that spouses experience emotional symptoms similar to those of their partners, the most common of which are existential anxiety, depression, feelings of helplessness at an early stage of the illness, and fear of coping with the disease and its consequences (Lethborg, Kissane & Burns, 2003). According to Lewis (1990), …’the family, not just the patient, deals with and attempts to understand the meaning of cancer, and it is the meaning of cancer to the family that sets the context within which dynamic processes occur’ ” (Lethborg, Kissane & Burns, 2003, p. 63).

Clearly, supportive intervention is required for a spouse who is exposed to emotional difficulties in coping with a disease-related partner. The therapeutic intervention is important since it impacts the mental condition of the spouse on the marital relationship and hence the state of mind, strength, and healing ability of the patient. In addition, it seems that cancer represents for these men the death and the fear of their own mortality. It also represents a threat of losing their partner and the loneliness that may develop. Lastly, cancer may also represent the limit of the caregiver to help his family member, because he or she can not overcome the cancer in the body of the patient (Lethborg, Kissane & Burns, 2003). Furthermore, a research conducted by Zahlis and Shands (1991) studied 67 spouses of breast cancer patients.

Seven conceptual domains described the demands that the woman’s breast cancer placed on her partner: (1) reacting to the illness; (2) negotiating the illness experience; (3) adapting lifestyle to meet the demands of the illness; (4) being sensitive to needs; (5) thinking about the future; (6) attempting to minimize the effects of illness; and (7) feeling the impact on the relationship. (Lethborg, Kissane & Burns, 2003, p. 66)

Therefore, it appears that the caregivers are vulnerable and experiencing great strain because they are the main source of support for their ill family member.

Social Work Intervention Using the Bio-psycho-social Perspective

In many ways, the bio-psycho-social spiritual (BPSS) assessment is an effort to understand the client in all the dimensions and spheres of their life as a human being. Even when people have single substantial problems that bring them to counseling, it is important to have a complete picture of their biological, psychological, socio-cultural, religious or spiritual, and mental statuses.  The BPSS assessment is a thorough and current snapshot of what is currently impacting clients in their lives and also what resources they possess that can help address their problem. According to Dziegielewski (1998), “The balance and integration of these three factors is essential in understanding the human condition within the health care setting” (p, 78). Thus, understanding the interior environment of human behavior is core to the social work profession.

The biological tasks that must be faced by African-American women, when addressing a breast cancer diagnosis, should involve a complete understanding of the medical aspects of their disease.  The mind-body connection makes it imperative that patients who are dealing with such a diagnosis remain as emotionally grounded as possible while going through the treatment process.  This means establishing, maintaining and reinforcing supportive networks of friends, families, and other patients who have experienced or are experiencing similar treatment issues (Lethborg, Kissane & Burns, 2003).  It is no longer hypothetical whether the emotional status of a person plays a role in their health status; the mind-body connection is indisputable.  Therefore, African-American and other women with a diagnosis of breast cancer must nurture and be nurtured while navigating the maze of treatment and recovery in order to maximize their chances of survival.  This might take the form of seeking therapy or other services in order to express feelings that are too difficult for family members to hear. Therefore, the role of social workers should take various forms, such as conversational, and the silent support of a person who can simply sit with the patient while they are able to vent, shed tears, and express their fears and hopes without worrying about judgment (Dziegielewski, 1998).

The psychosocial tasks should focus on social factors, such as poor social support systems, poor economic status, lack of affection, and maladaptive behaviors as a support in dealing with the disease. Dziegielewski (1998) suggests that patients may encounter problems that include “interpersonal conflicts, psychological and behavior problems, dissatisfaction with social relations, difficulties in role performance, problems of social transition, inadequate resources, problems in decision making, problems with formal organizations, and cultural conflicts” (p. 83). Therefore, lack of social support can lead to anxiety, while adequate support helps patients to manage in a stressful situation.

Lethborg, Kissane & Burns (2003) postulate that the significant others of women with breast cancer have a major impact on the social adjustment of their partners during the process of treatment and recovery. Also, the lives of significant others are changed dramatically when their partner receives a diagnosis of cancer. There are cases where coping mechanisms such as avoidance, denial, and minimizing are utilized and can present emotional distress to the person with breast cancer. Again, it is a significant challenge for women in general, and for African-American women, in particular, to be able to tolerate the emotional changes that are being experienced by their loved ones while simultaneously addressing their own emotional needs regarding their disease.

Conclusion

The fact that African-American women have the highest rates of mortality from breast cancer in the United States is an alarming statistic.  The reasons range from barriers to healthcare, mistrust of the medical community regarding treatment and racial prejudice, general fears, and fatalistic attitudes about cancer. In this respect, healthcare providers can play a tremendous role in addressing this problem, particularly with regards to African-American attitudes towards the healthcare community. Therefore, healthcare providers must require a multidisciplinary approach in order to gather all the information necessary for understanding each family’s member point of view. As previously mentioned, all three factors, the biological, psychological, and social, must be weighted equally in order to make sure that each of these areas receives the attention that it warrants (Dziegielewski, 1998).  This requires the providers, working with an African-American patient to be fluent in medical language in order to assist the patient in understanding the importance of an early detection, treatment, and the process of the progression/remission of the disease.

Bibliography:

Cohen, J.and Phillips, M. (2011). The Meaning of Breast Cancer Risk for African American Women. Journal of Nursing Scholarship , 239-247.

Gullatte, M., Brawley, O.,  Kinney, A.,Powe, B., and Mooney, A. (2010). Religiosity Spirituality and Cancer Vandalism Believes on Delay in Breast Cancer Diagnosis in African American Women. Journal of Religious Health , 62-72.

Lethborg, C. and Kissane, D. (2003). It’s Not the Easy Part. Social Work in Health Care, 63-85.

Masi, C. and Gehlert, S.  (2008). Perceptions of Press Cancer Treatment among African-American Women and Men: Implications for Interventions. Journal of General Internal

Peek, M., Sayad, J., and Markwardt, R . (2008). Fear, Fatalism in Breast Cancer Screening in Low-Income African American Women: The Role of Clinicians and the Health Care System. Journal of General Internal Medicine , 1847-1853.

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What Is Breast Cancer? (2012, September 18). Retrieved October 27, 2012, from Breast Cancer.org: http://www.breastcancer.org/symptoms/understand_bc/what_is_bc