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2 June/July 2006 Breast Cancer Action
FROM THE EXECUTIVE DIRECTOR
Facing the Challenges: Access to Screening and Treatment
By Barbara A. Brenner
The following is a talk presented at the San Francisco Breast Cancer
Summit in November 1996 and published in the February/March 1997
issue of this newsletter. A decade after Barbara Brenner presented this
talk, accessing care is still a dire issue for many women with breast cancer
and the public at large. This issue of the newsletter explores some of the
problems and some of the ways people are working for change.
As a white, upper middle-class Jewish lesbian with breast
cancer, I know that I have been privileged to receive
treatment in a city whose resources—both private and
public—are phenomenal. In the years before my diagnosis, I had
access to mammograms, clinical breast exams, and diagnostic
procedures when I needed them. I had
access not only because I knew where and
how to get them, but also because the cost
was covered largely by insurance.
Since September 1993, I have been
treated twice for breast cancer in San
Francisco. I want to talk today about the
care I received. I believe my experience is
instructive because it reveals both what is
possible and what the challenges are for
making sure that all women get the
services they need when confronting a
possible or actual breast cancer diagnosis.
In January 1993, at the age of 41 I
had a screening mammogram. I chose to
have the mammogram at UCSF, but, under
my insurance plan, I could have had the
procedure almost anywhere in the city. My mammogram showed the
dense breast tissue that is not uncommon in premenopausal women.
I knew about this phenomenon and did not rely on the
mammogram. I had learned years before about breast self-exams, and
I was not afraid of or embarrassed by my body, so I did monthly
exams.
In August 1993 in the course of my breast self-exam, I found a
lump. I picked up the phone, called my surgeon (I had someone I
had seen previously,) and got an appointment to see him. The fine
needle aspiration proved inconclusive, so we scheduled an excisional
biopsy. The lump turned out to be invasive ductal breast cancer.
Let’s stop here a minute and imagine a few things differently. Let’s
imagine that I did not have insurance, or had a high-deductible policy and
“As stressful as it is to
deal with a diagnosis of breast
cancer, that stress
is often swamped by the
pressures of putting food
on the table and keeping
a roof over the kids’ heads, let
alone our own heads.”
would have to pay for a mammogram out of my own pocket, or that I was
someone who didn’t know the first thing about mammograms—what they
were, their benefits and risks, or how to get one. Or that the cultural norms
with which I was raised made it shameful or sinful to touch my breasts. Or
that I was an undocumented woman who was afraid to seek health care
because I was concerned that immigration authorities would find out about
me. Or that I was a legal immigrant concerned about the rabid atmosphere
surrounding people with Spanish surnames who was afraid to seek health
care because I didn’t trust that anyone would take the time to distinguish
me from undocumented people. As a result, I might stand before you
today—three years later—with advanced disease. Or I might not be
standing before you at all because my breast cancer was diagnosed too late
to be treated effectively…
Once I was diagnosed, the first thing I
did was arrange to stop practicing law for
as long as necessary to address the lifethreatening
illness that had intruded into
my life. My ability to do that was entirely a
function of a supportive work and family
environment, and income security in the
form of income disability insurance coverage.
I had a loving partner of 18 years
who earned a decent income, a house we
owned in Noe Valley, a health insurance
plan—paid for by my law firm—that gave
me many options in terms of which doctors
I saw and where I received treatment. I also
had an extensive network of friends and
acquaintances who were familiar with
health care issues in general and breast cancer in particular, and who,
by the way, knew how to cook.
How would my situation have been different if I had had small
children and no partner, or if I had had a minimum wage job and no
income security, or, as is too often the case, all of the above? As stressful as
it is to deal with a diagnosis of breast cancer, that stress is often swamped
by the pressures of putting food on the table and keeping a roof over the
kids’ heads, let alone our own heads. We fool ourselves badly if we pretend
that addressing issues of access to treatment does not involve addressing
issues of basic human needs.
Let’s go back to my story. After I took care of my work obligations,
I started gathering as much information as I possibly could. I
continued on page 6
TURN IN YOUR DOCTOR!
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Just send their names and addresses (including e-mail, if available) to
sharding@bcaction.org, or call us toll free at 877/278-6722.