Breast Cancer on the Frontlines
Tactical changes to cultural disparities

By Lt. Col. Rose A. Hazlett

Many people talk about the war on cancer, and for Major Shirley J. McKellar and myself, that war has been taken to heart. Two nurses with one goal: To reduce the disparities among population groups in the United States characterized by gender, age, ethnicity, income, social class, disability and geographic location. A central role in these differences may be due to the group’s socioeconomic status, which predicts the likelihood of a group’s access to healthcare, education and health insurance.

One group at greater risk of developing and dying from breast cancer is African-American women, who have a five-year survival rate of 74 percent compared to 88 percent for white women. And breast cancer is the second leading cause of cancer death among African-American women, exceeded only by lung cancer. In addition, the female Hispanic population faces cultural and language barriers of its own.

Both minority populations are victims of the disparities found in the healthcare of women with breast cancer. To make an impact on these statistics, both groups need education and interventions that are culturally sensitive. Health literacy impacts many women affected with breast cancer. The Hispanic female may face a language barrier, but the African-American female faces the same barrier when she feels she cannot communicate with or trust the healthcare provider.

In addition, problems may exist in reading instruction labels on medicines and medical and insurance forms.

From Disparities to Directions

The patterns of breast cancer by racial categories will decrease when we start addressing the problems in creative ways.

One organization that has made a difference is Sisters Network Inc., founded by Karen Jackson in 1994 in Houston, Texas, after her own breast cancer experience. Today, the organization has 39 chapters in 25 states with more than 3,000 members.

Sisters (www.sistersnetworkinc.org) is partnering with M. D. Anderson Cancer Center in a peer-counseling program for African-American breast cancer survivors to provide information, support and encouragement.

As military nurses, Major McKellar and I have gone to war against breast cancer. In 1998 we gathered research data for a TriService nursing research program entitled “Improving Clinical Breast Exams for Military Women” with Ann Coleman, PhD, RN, at the University of Arkansas.

From there, we have worked on other projects, including the Breast and Cervical Cancer Control Program, which provides breast cancer screening services to African-American women; the National Black Leadership Initiative on Cancer; and a community-based model for enhancing African-American women’s breast cancer screening outreach and case management services with the University of Texas’ School of Nursing. Through these experiences, we have learned to go to the community and meet the female in her environment, whether it be churches, beauty shops or nail salons. Most importantly, we have learned to listen.

Our breast cancer efforts did not stop when we were deployed to support Operation Iraqi Freedom. Major McKellar even extended her tour of duty by six months.

We were stationed at Landstuhl Regional Medical Center (LRMC) in Germany. I assisted Major McKellar in establishing the first breast cancer clinic at LRMC. We integrated the civilian community with the military community in bringing together this much-needed resource. Major McKellar and I also provided breast screening and education seminars and a continuing education luncheon.

We are determined to win this war, and we will carry our battle against breast cancer wherever we go. As Army nurses, we refuse to be defeated. We are aware of the devastating statistics facing the African-American and Hispanic female populations and have decided to unite, mobilize and march forward to attack the statistics one step at a time. Together, we all will make a difference in the battle against breast cancer.