Breast cancer is the second most common cancer in Canada and the most common among women. According to the Canadian Cancer Society, about 26,000 women will be diagnosed and 15 will die from the disease every day in 2022 alone.
Survival rates are generally high: 8 out of 10 women with breast cancer will survive for at least five years after their diagnosis. But treating the disease requires early detection and screening — something that can be a challenge for Black and racialized women.
Anti-Black racism, something that permeates Canadian society in many forms, contributes to keeping Black women out of a health care system that doesn't address their experiences, or worse, fails to value their lives. Norms, discourse, and imagery related to breast cancer also carry biases that frame the disease as inherently white.
Women's College Hospital (WCH) is taking steps to address these barriers. With the support of clinicians, scientists, and researchers, the organization recently launched a campaign called "Every Breast Counts." The initiative is part of a broader project with the Peter Gilgan Centre, which aims create a platform for Black women to access tailored culturally relevant information around breast health and breast cancer, relating to their experiences.
The campaign, hosted on WCH's website, was created for Black women and by Black women, with resources on topics ranging from risk assessment and mental health to stories of survivors.
Global Citizen spoke to WCH Chair of Implementation Science Dr. Aisha Lofters and Innovation Spread and Scale Lead Rumaisa Khan to learn more about the campaign.
Global Citizen: Can you tell me more about how the "Every Breast Counts" campaign came about?
Dr. Aisha Lofters: We decided to start this work after hearing personal stories of several Black women who were on their own breast cancer journeys and were disappointed and frustrated with the health care system. Specifically, some of their providers not being able to answer their questions because of a lack of knowledge about Black health, with materials and supports being exclusionary, and because of experiences of racism. We wanted to create something in response to those experiences.
What are some of the systemic barriers Black women and women of colour face when accessing screening?
Rumaisa Khan: First, I think it's important to note that there is a distinction to be made between women of colour and Black women. Although some of their experiences may overlap, the experiences of Black women are unique from others.
Although we know little about Canada, research from the US shows Black women are less likely to get screened for breast cancer, are more likely to have aggressive forms of breast cancer, and may be diagnosed at younger ages.
So far, in Ontario, we know that Black women from Muslim-majority countries and from sub-Saharan Africa are less likely to get screened (likely because of cultural and religious beliefs). And although Black women from the Caribbean and Latin America are more likely to have mammograms, they are diagnosed at later stages. In Nova Scotia, in particular, Black women face barriers — such as experiencing anti-Black racism from clinicians — navigating the health care system to get mammograms.
Some other barriers that they may experience to access screening can include stigma, mistrust of the health care system, and fear of discomfort and pain.
How do social determinants of health affect Black women's access to health care in Canada?
Dr. Aisha Lofters: The social determinants of health include racism and discrimination, as well as the results of racism, such as housing, educational, and financial inequalities. All of these factors affect one’s ability to access health care, get informed about health, advocate for one’s health, and be treated with respect when doing so.
In the past few years, we have just started to address anti-Black racism head-on in Canada, and there’s still much work to be done in the health care space.
How does the initiative address those barriers from an intersectional lens?
Dr. Aisha Lofters: This project really focuses on people who identify as Black and who identify as women. We wanted to unapologetically recognize the unique experiences of this group, which is different than women of other races and different than other people who identify as Black.
All of the information on the site was directed by Black women, reviewed by Black women, and geared toward an audience of Black women. The site is available for any and everyone to look at, and we strongly encourage that, but the information is really specifically focused on Black women.
What is your role in the campaign?
Both: We both work at the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital, as the Chair of Implementation Science and the Innovation Spread and Scale Lead. Most of all, four co-creators who channeled their experiences as Black women living with breast cancer guided most of the project direction: Dawn Barker, Debbie Pottinger, Shireen Spencer, and Talina Higgins.
However, this work was done in full partnership with the Olive Branch of Hope, the only Black breast cancer survivor-led organization in Canada advocating for Women of African Ancestry, and a number of researchers, students, clinicians, and community partners who contributed to this work.
What have been the results to date?
Rumaisa Khan: So far, the website has gained over 2,000 views since our second launch in February 2022. It’s been profiled in several media outlets and has been disseminated to over 130 cancer centres and community health centres across the country. So, we are hoping that it has reached those who are seeking this type of support and representation.
The most impactful and rewarding results, though, have been seeing how this project has begun to spark conversations around equity, diversity, and representation in the cancer space, among leadership tables and national cancer programs.
More importantly, it was nice to see this ongoing feeling of hope and empowerment that was described by co-creators and community partners toward the end of the project, after reflecting on the experience of working together and no longer feeling isolated within a health care system centred around whiteness.
What are you hoping to achieve in the near future, and how can people support you?
Rumaisa Khan: The biggest thing we are hoping to achieve in the future is to continue to bridge more partnerships between community organizations (like the Olive Branch of Hope), hospitals, and institutions. It's through these partnerships that change comes to life through building on each other’s expertise and knowledge …
Our team at the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital is working on a few other initiatives, including a new study understanding experiences of Black women with metastatic breast cancer funded by Pfizer, and a cancer screening event for Black women living in the Greater Toronto Area in the fall. Above all, we are hoping that research specific to Black Canadians is conducted to ensure the highest quality, evidence-based care for all.
Anyone that would like to support should check out the Olive Branch of Hope and support the amazing work they do!