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Disparities in Breast Cancer Treatment

Posted 5/26/2013

Posted in

  Volumes could be written about disparities in breast cancer (or any kind of cancer or health care in general) treatment, but this important topic has been receiving extra attention since Angelina Jolie went public with her decision about prophylactic bilateral mastectomies.  Yes, she she "priviledged" to even have the choice to make, let alone to proceed through the surgeries and recovery with the best care and support that money can buy. That in no way minimizes her personal pain. Choosing to remove two heathy breasts is terrible for any woman.

  I don't have anything new to add to this discussion, but have found myself thinking about the disparities even within our own institution. I firmly believe that every oncology patient at BIDMC receives the same world class medical and nursing care; I know that treatment decisions are never made based on financial resources or social class or ethnicity. The very best care is prescribed, and then we all work hard to make it happen. For some women, however, that takes a lot more work than for others. Even for those of us who have loving families, supportive friends, good medical insurance, adequate finances, and some degree of comfort negotiating a large medical center, it is really tough. Consider how much more challenging it is for women who are alone, who don't speak English, who can't take a day off from work without losing income, who are already worried about a ill family member or a child in trouble with the law or losing their homes or a multitude of other real life issues. We surely have patients for whom cancer is the least of their troubles.

  This is on my mind because of this essay by Nancy Brinker, the CEO of the Komen Foundation, in USA Today. Honestly, I have my criticisms about Komen, most related to the scandal with Planned Parenthood and the whole Pink campaign, but they have done and continue to do a lot of very good work. Did you know, for example, that, outside of the federal government, Komen gives more money to research grants than anyone else? This is a thoughtful essay and worth a few minutes of your time. Here is the beginning and then a link to read more:

There is still a lot of work to be done in the fight against breast cancer, including making sure all women have the opportunity to make their own personal decisions about their medical future.

I commend Angelina Jolie for helping initiate a dialogue about health issues women face.
There are still far too many women who don't have access to high-quality care.
Where a women lives and how much money she has should not determine whether she lives.
Angelina Jolie, at 37 years of age, performed a tremendous public service when she recently announced she had a preventive double mastectomy to minimize her risk of getting cancer. She explained that she did so because she carries the BRCA1 gene mutation, which significantly increased her chances of developing breast and ovarian cancer.

This was an extremely personal and difficult decision. I know, since I made a similar decision when I was in my late 30s after being diagnosed with breast cancer, which was determined years later that it was also from carrying the BRCA1 gene mutation.


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