A recent study for breast cancer research found significant racial disparities between American Indian and Alaska Native women compared to white women when it comes to standard of care and treatment options. KUNM’s Taylor Velazquez spoke with Felina Cordova-Marks, an assistant professor at the University of Arizona’s College of Public Health and co-author of the study.
FELINA CORDOVA-MARKS: What we found is that American Indian/Alaskan Native women are having mastectomies at higher rates than non-Hispanic white women. And we also found that it's kind of geographical as well, where there's actually more mastectomies occurring in the northern plains as well as Alaska.
And this definitely affects outcomes because full mastectomies, there's longer recovery time. And there's also the way that the women feel about themselves after having a full mastectomy versus a breast conserving therapy, aka lumpectomies where the entire breast isn't removed. So women that have lumpectomies generally have a better outlook on life and how they see themselves and how they feel about themselves versus women that have mastectomies. So there's definitely an impact to the quality of life. In a mastectomy versus a lumpectomy.
KUNM: And the study doesn’t establish what is driving these disparities when it comes to care. But you had your own thoughts that it could be a mix of geographic and socio economic factors. Can you explain what you mean by this? And what suggestions do you have in mind in closing these barriers?
CORDOVA-MARKS: We hypothesize that geography definitely plays a role, especially for women in Alaska, where there's long travel times as well as harsh weather to contend with. So we hypothesize that potentially maybe women are having these larger surgeries like mastectomies versus lumpectomies done due to the barrier in distance. So, if you get a lumpectomy, there may be additional treatments required, whereas versus a mastectomy, where it's basically taking everything and it is usually associated with less office visits. So we definitely think that geography plays a role in Alaska, as well as in other places too, as the majority of Indian Health Service facilities across the country are located pretty far from where people actually live. So there definitely is a barrier. We've also found that lower socioeconomic status women, other minority women as well, have higher rates of mastectomy. That was something else that was different.
I personally want to make sure that women are being consented for the mastectomies, if they do choose to have mastectomies, in a culturally responsive and appropriate manner to make sure that this isn't one of the reasons that women are having mastectomies and to ensure that they're not being coerced. In the past, Indigenous and Native women have either been coerced into medical procedures, or have been not even coerced, but basically have had surgical procedures forced upon them, such as the past history of surgical sterilization that have occurred to women just to make sure that those kind of historical atrocities aren't continuing into modern times.
KUNM: The research you all are doing goes further than the disease and the medicine that goes into it. You all mentioned the extended team that could close the gaps in the system, like social workers, and even financial counselors. But most importantly, you all are advocating for incorporating traditional healers into these teams. Can you tell me why it's important for traditional healers to be present within a patient's care?
CORDOVA-MARKS: So it's all kind of very specific. As we like to say traditional healing, traditional medicine health is the original precision medicine in that everything is tailored to the person based on their physical conditions, mental, emotional, basically, kind of every aspect looked at in a holistic way.
So there's kind of no one catch-all way that traditional healers could be incorporated. But we're definitely advocates for increased collaboration between physicians, the medical care team, to be working with traditional healers, and to not, especially for Western medicine, to not be stigmatizing traditional health or if somebody with cancer brings it up and wants to discuss it.
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