Where Cancer Meets Culture

Addressing cancer among the nation’s Latino population requires awareness of its unique impact among these communities as well as cultural sensitivity.

By Mia James

In May 2008 the U.S. Census Bureau reported that there were 45 million people of Hispanic origin living in the United States. This means that 15 percent of our nation’s total population is Hispanic­—an ethnic group also known as Latino or, when referring to women, Latina. Hispanics remain the largest minority group in the United States. As this segment of our population has grown, however, development of resources dedicated to cancer among Latinos hasn’t always kept up. Fortunately though, advocacy groups, researchers, and individuals are increasingly aware that cancer is a real concern among Latinos and will be most effectively addressed when the unique impact that cancer has on these communities is recognized.

In addition to awareness of disparities in cancer incidence and outcome, high-quality cancer education and care among Hispanics requires knowledge, respect, and understanding of how this population’s rich culture affects perspectives on healthcare. Challenges faced by Hispanics include cultural and language barriers, access to care (largely a financial concern), and the need for expanded resources, advocacy, and research to address cancer as it affects this particular population.

When cancer data among Latinos is compared with the overall U.S. population, disparities are evident in cancer incidence and outcome. Lower survival rates for most cancers, increased likelihood of later-stage diagnoses, and lower rates of cancer screening—all are challenges to this population. It is the goal of organizations like Redes En Acción: The National Latino Cancer Research Network (Redes) and Latinas Contra Cancer (LCC) to address these inequalities through education and support and by encouraging research that looks specifically at cancer among Hispanics. Their missions are a reminder that the fight against cancer is a cultural and social issue as well as a medical and scientific concern.

Cultural Understanding
To begin to understand the cultural complexities within Hispanic communities and how they relate to healthcare, it’s important to first recognize further distinctions within the communities, explains Ysabel Duron, founder and executive director of LCC, a northern California–based agency dedicated to increasing cancer awareness and access to high-quality care for Latinos nationwide. Ysabel explains that Latinos may be “native born [born in Latin American countries] and others are second- or third-generation.” Of these subgroups, those native born, or more-recent immigrants, may speak only Spanish, earn a low income, be un- or underinsured, and—due to traditions and beliefs carried from their country of origin—have greater misconceptions and inaccurate information about health-related matters.

Though some of these beliefs may weaken as individuals and future generations are exposed to mainstream U.S. culture, Ysabel stresses that they can remain a factor in how Hispanics approach healthcare and cancer in particular as certain cultural values are reinforced among families and through popular media. “If you hang on to Spanish-language media [such as soap operas], there are a lot of social messages buried within these [programs] that to some extent reinforce old cultural beliefs,” she explains. Women, for instance, are often portrayed in Spanish-language media as caregivers who tend to put the well-being of others before their own. This attitude, Ysabel says, can contribute to inadequate cancer awareness and screening, which in turn can contribute to late-stage cancer diagnoses.

As a Latina herself, Ysabel is keenly aware of how traditions can continue to influence even U.S.-born, younger Hispanics. “It’s part of who we are,” she says, and explains that initiatives to increase awareness, reduce cancer rates, and improve outcomes will be effective only when guided by cultural understanding and sensitivity.

Key Concerns
Amelie G. Ramirez, DrPH, directs Redes, which has received funding from the National Cancer Institute to support the study of major cancer issues in highly concentrated Latino communities. Among the broad range of cancer-related issues facing Latino communities, Dr. Ramirez says that certain topics stand out and merit special attention.

Tobacco Prevention
Tobacco prevention, explains Dr. Ramirez, has become a key concern because, although smoking rates are lower among Hispanics than in the general population, younger Hispanics are taking up the habit. Because smoking is recognized as a major risk factor for certain cancers (American Cancer Society estimates for 2009 attribute about 169,000 cancer deaths to tobacco use ), notably lung cancer, prevention efforts among this population are key.

Breast Cancer
The case of breast cancer in Latinas, Dr. Ramirez says, presents a unique challenge when it comes to education because, although breast cancer diagnoses are lower among Hispanics than in the general population, the disease, she says, is the most commonly diagnosed cancer and the leading cause of cancer death among Hispanic women. This can lead to harmful misconceptions for Latinas who take the lower rates to mean that they don’t need to worry about breast cancer, an attitude that can contribute to inadequate screening and thus more-advanced-stage diagnoses.

Overcoming Financial Barriers to Care
Among the many steps to improved health and healthcare in Hispanic communities, Dr. Ramirez says that regular visits to a healthcare provider are vital; for low-income or un- and underinsured Hispanics, however, routine doctor visits may not seem feasible. “Latinos are less likely to see a doctor on a regular basis because they’re less likely to have health insurance,” explains Dr. Ramirez. While healthcare costs can be daunting, the potential costs of not seeking care can be even greater; and among Hispanics lower rates of regular medical care can be another factor contributing to late-stage cancer diagnoses. Dr. Ramirez therefore stresses the importance of seeking lower-cost healthcare alternatives, such as community health centers and facilities that offer sliding-scale fees (fees adjusted based on income level).

Like the U.S. Latino population itself, cancer among these communities is a complex and evolving issue. Fortunately though, with increasing recognition from healthcare, advocacy, and research sectors that cancer among Hispanics must be addressed with cultural sensitivity and awareness of unique challenges, there is hope for lower incidence, increased early detection, and improved access to care for Latinos nationwide.

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Hispanic Cancer Issues
Advocacy

In response to the need in Latino communities for increased education, access to care, and expanded research, organizations like Redes En Acción (www.redesenaccion.org) and Latinas Contra Cancer (www.latinascontracancer.org) are taking action. Both agencies are guided by the principle that cancer is as much a cultural and social issue as it is a medical and scientific concern and therefore, to truly provide support and find solutions, community and family considerations are always a priority.

Latinas Contra Cancer’s programs—including education, awareness campaigns, support groups, and patient navigation—are developed and executed with particular needs and influences of Hispanic culture in mind. These include understanding misconceptions about cancer within these communities, respect for family (parents are asked permission before daughters attend cervical cancer awareness workshops, for example), and, naturally, offering Spanish-language materials for non-English-speaking audiences.

Redes is developing programs that promote cancer awareness and education about screening and prevention as well as ways to enable proper treatment for those diagnosed with cancer. Examples of their many areas of focus include youth-targeted tobacco prevention programs, expanding awareness about screening and early detection, and encouraging research and clinical trials that focus on Hispanics.

Patients and their families are benefiting immediately from the broad range of these efforts. Direct services like patient navigation, which both Redes and Latinas Contra Cancer offer, ensure that Hispanic cancer patients have expert guidance through potentially complex treatment processes. It has been recognized among community clinics where significant numbers of Hispanics are treated that not enough patients return for follow-up care once a diagnosis is made. Patient navigators, who have in-depth understanding of both the medical system and cultural and community backgrounds, work to make sure patients do not forgo critical treatment due to fear, misunderstanding, or financial and language barriers. The goals of such programs are timely, high-quality care and the assurance that each individual feels supported through the treatment process.

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