Racialized gender images may cause poor breast cancer outcomes in minority women

Programs that use patient navigators may help minority women overcome the hurdles they face in getting a timely mammogram, but they must consider how racialized gender images affect how they seek help and engage with healthcare providers, according to new research conducted by Sage Kim, associate professor of health policy and administration and member at the University of Illinois Cancer Center.

“Regardless of whether women are aware of obstacles to screening and treatment, barriers tend to interfere with timely follow-up of abnormal test results, delaying diagnosis and treatment,” said Kim, PhD, whose study will be published in the journal Cancer and was made available online Monday (https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.31636) . “While patient navigation is effective, care providers need to be aware that not all women interact the same with patient navigators and other care providers.”

Kim and her colleagues examined the rates at which women who received patient navigation in a randomized clinical trial reported barriers to obtaining a screening mammogram. The trial, called the Patient Navigation in Medically Underserved Areas (PNMUA) study, randomly assigned patients to one of two groups: one received a patient navigation support intervention and the other served as a control. Of the 3,754 women who received the patient navigation intervention, only 14 percent identified one or more barriers to care, which led to additional interactions with navigators who helped overcome barriers.

Black women, women living in poverty, and women who reported high levels of distrust of the health care system were the least likely to report barriers. Women who reported barriers were more likely to have additional contact with navigators and obtain a subsequent screening mammogram. The extra support could help with early diagnosis and better survival and mortality outcomes, Kim said.

“Racialized gender images of the ideal women and medical distrust due to historical experiences of discrimination, such as the Tuskegee experiment, affect how minority women – particularly those living in poverty – interact and utilize healthcare,” Kim said. “What is important is that healthcare providers need to be aware of such social and historical conditions that may affect the effectiveness of interventions, including patient navigation, for minority women. This paper makes an argument that the way we train and inform patient navigators and other healthcare providers needs to be re-engineered.”

One example is the prevalence of the “super woman” ideal and other gendered, racialized and class-based social expectations among minority women, particularly black women. Minority women living in poverty always have been the source of social support for others, Kim said, but in regards to healthcare access, they may be disadvantaged because of their role as caretakers.

“We argue that we turn our framework of understanding the issue at hand from whether or not some women do not understand that they have barriers, to what structural factors produce health inequality. Economic and social barriers to care are rooted in racialized and gendered social institutions,” Kim said. “Inequality can be produced and reproduced by healthcare systems, interventions, and care providers. In designing interventions, scholars and practitioners need to be thinking more about structural barriers.

“Healthcare providers are striving to reduce health disparities. Our study findings highlight another somewhat unexpected area for improvement.”

Co-authors on the paper were Anne Glassgow, PhD, research assistant professor of pediatrics and associate member, UI Cancer Center; Karriem Watson, DHSc, MS, MPH, co-director, Office of Community Engaged Research and Implementation Science, UI Cancer Center; Yamile Molina, PhD, MPH, assistant professor of community health sciences and UI Cancer Center member; and Elizabeth Calhoun, PhD, University of Arizona Health Sciences, Tucson, Ariz. The research was supported in part by a grant from the National Institute of Minority Health and Health Disparities (3P60 MD003424-03S1).

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