After hanging up from a marathon talk with one of my best friends, Stephany, I suddenly remembered that October is National Breast Cancer Awareness month. It reminded me that cancer is the leading cause of death among Indian women, with heart disease coming in as a close second. I immediately thought that I should schedule my yearly mammogram. Most medical websites state that American Indian or Alaska Native women have the lowest incidence of breast cancer among women in the United States, but the number of incidents has risen sharply in the last two decades.
Stephany has faced down breast cancer twice in her short 40ish life. Both times took over a year to go from personal detection to medical intervention—starting with the mammogram, then a biopsy, surgery, chemotherapy, and finally, radiation. Both times required Steph to navigate and appeal health insurance decisions about her treatment plans, all while feeling very sick, working a full-time job outside the home, and caring for her very active 10-year-old son. However, unlike many Native women, Stephany has health insurance, a spouse with a job, and a host of family, friends, and colleagues who support her.
Organizations readily admit statistics and data on breast cancer (or any other kind) for American Indians may be severely underreported for several reasons. First, many Native communities are not part of cancer registries (data systems that collect information about cancer cases and cancer deaths). Also, self-identification is not always the method for choosing race or ethnicity—sometimes, the medical staff checks the box. Plus, our participation rates in cancer clinical trials and research are low. Finally, some Native folk may mistake ill health for normal aging, and therefore, will not seek medical attention.
But there are numerous reasons for why cancer is the leading cause of death for American Indian women, in general. Native women often lack a usual health care provider because they lack comprehensive health insurance and rely on Indian Health Services (IHS). Access to medical attention from IHS depends on place of residence, and sometimes degree of Indian blood. Plus, IHS is poorly funded. Mammography equipment may not be available, so Native women are referred elsewhere. This can be intimidating and create even more hardship due to a lack of transportation or the necessity to drive a greater distance than affordable.
Changes in our bodies often go undetected—particularly when seen by overworked doctors who take cursory glances at our charts as they hurry into an examination room where we’ve usually been waiting for at least thirty minutes. It is hard to talk about such intimate changes to our bodies with someone we just met. Healthcare workers may be unaware of the differences in tribal cultural or communication styles of Native women. If discussed inappropriately, Native women might decide that there is no need for a mammogram or a follow-up ultrasound or biopsy. They may refuse treatment, if diagnosed. Even if Indian women have a usual provider, sometimes we lack a support system to help with our families or other responsibilities. So, we refuse to explore screening methods and treatment.
The Oklahoma City Indian Clinic did something really smart a few years back. They created the Pink Glory Breast Care program through grants from the Susan G. Komen foundation. Every week a mobile mammogram van from the Oklahoma Breast Care Center makes a site visit to the Indian Clinic. The “van” is really a deluxe motor home that has been modified into a rolling examination room with the latest in technology. Examiners receive training in working with American Indian women to ease cultural discomfort. I found convenience and dignity in the process.
I will say that my friend, Stephany, is no ordinary woman. She’s an advocate for diabetes prevention for Native Elders and Native youth. As an Associate Research Professor in Nutritional Sciences at Oklahoma State University, she works in partnership with the Chickasaw Nation to deliver cutting-edge healthy living programs, like The Eagle Adventure. I honestly cannot list all the outreach programs among tribal communities in which Steph plays an active role. She implements integrative leadership models in the programs, and then hires and trains Indigenous women to be those leaders. In doing this, Steph provides role models for our youth within their own communities.
I’ve been fortunate to work with Stephany on a couple of these projects. I want to work with her on many more. That’s why I’m going to go get my annual mammogram. I am also going to help at least one Elder and another American Indian woman of any age receive their preventative screening. How about you? Encourage your family, friends, and co-workers to get a mammogram. We’re worth it.
Dwanna L. Robertson is a citizen of the Muscogee (Creek) Nation, a PhD candidate at the University of Massachusetts, Amherst, a writer for Indian Country Today Media Network, and a public sociologist.