February 22, 2024

How three black women developed breast cancer in our failed health care system

More than 1,000 hours. That’s how long the two of us—both black female doctors in Los Angeles—spent in the chair of our friend and hairstylist Sharone.

It’s not easy to find a good stylist who understands black hair, but Sharone has a gift. When Medell met Sharone 17 years ago, she knew she had met a kindred spirit, and she has been styling her ever since.

When Medell joined Elaine at MLK Community Healthcare, Elaine knew she was an excellent physician who would be critical to her hospital’s mission to bring quality care to South Los Angeles. But she had to know one thing: who did Medell’s hair? She wanted to emphasize the natural texture of her hair and thought Medell’s looked great. It wasn’t long before she was sitting in Sharone’s chair too.

Over the years, for a few hours every two weeks, all three of us have become friends. We relied on Sharone – a mother and grandmother, and an example of grace and professionalism. Curly highlights one year, sleek blowouts the next. Sharone understood that in a world where black women are judged harshly, appearance has meaning. She took care of us.

Then, a few years ago, Sharone discovered a lump in her breast. It was our turn to take care of her.

As physicians working to change America’s segregated and unequal health care system, we know how serious breast cancer can be for Black women. Although the prevalence is slightly lower, the outcomes are much worse, with a mortality rate 41 percent higher than for white women. We had to intervene.

We also understand the legitimate reasons why Black Americans distrust the health care system and how that can disrupt treatment. A recent study found that 30 percent of black women reported mistreatment during maternity care, and previous research links experiences of racial discrimination to pregnancy complications.

The first appointment Sharone could get with a GP would take weeks. A few weeks can mean the difference between life and death; delays in diagnosis are a major factor in the disparities in breast cancer outcomes.

Elaine arranged for Sharone to see a doctor in her medical group right away. The doctor, a man of color, listened to Sharone’s concerns and took action. He immediately ordered a mammogram and within a few days she received a referral for a biopsy.

The biopsy did not go so smoothly. After a long drive, Sharone’s experience was less than ideal. The specialist told Sharone that she would place a metal marker in her breast that could not be removed. Sharone felt uncomfortable and had questions. A metal marker? What was that for? The doctor became belligerent and told her to do as she was told.

Sharone agreed to the biopsy; she knew she needed a quick diagnosis. But she did not agree to the marker. She left that experience feeling guarded, rejected, and unheard.

“I was confronted with death and felt like I was losing my choices,” she told us. “I had to be treated like a person with opinions and feelings. I had to entrust my life to other people, and the only thing I could hold on to was my ability to choose.”

Confidence in healthcare is often one-sided. As physicians, we expect our expertise to be trusted and respected. Too often, doctors ignore the patient’s expertise, perspective and preferences.

Sharone calls this not a matter of trust, but of positioning. What worked for her was that doctor and patient could come together as people, with mutual respect for each other’s expertise: the doctor as an expert in medicine and the patient as an expert in their experience.

An ideal doctor-patient positioning involves listening respectfully to patients and gaining their trust by focusing on their concerns and preferences. It helps when physicians look like the patients they serve, with physicians who have firsthand experienced the unique pressures and biases that people of color face in a white-dominated culture. But the lesson applies to all of us.

Shortly after Sharone’s biopsy, we received heartbreaking news: she had triple negative breast cancer, one of the most aggressive and difficult to treat forms. Her tumor was stage two, but had not yet spread to other parts of her body. It was crucial for Sharone to get treatment as soon as possible.

Within a week, Medell helped Sharone get treatment at UCLA Health.

Medell joined Sharone for several medical appointments and served as a mediator and support person. “They were excellent doctors,” Sharone told us later. “Every doctor came in and explained the process. They were very professional.”

But there were setbacks.

Sharone had an allergic reaction to the first medical treatment. “That first day of chemo almost cost me my life,” she said. “After that I didn’t want to continue, but I knew I had to keep going. I knew that as long as I had breath, I would continue to fight for my life and for my family.”

Then Sharone’s treatment plan changed. Her body didn’t react quickly enough. Her doctor recommended two additional rounds of treatment. Chemotherapy is hard on the body and mind, and Sharone wasn’t sure she needed it all. We gently encouraged her. Sharone has completed the treatments.

Today, two years after her initial diagnosis, Sharone is healthy. She caught the cancer before it spread and received effective treatment quickly.

Our counselor also helped her maintain her treatment. As friends guided her through the challenging mazes of the health care system, she ensured that Sharone did not become one of the thousands of Black women lost too soon to breast cancer each year.

But the fact that we had to intervene is a sign that our system is broken and needs to change.

Everyone deserves access to high-quality care, empathetic doctors and a supportive community. Without these things, we will continue to see health inequities among Black women and other people of color.

“If you hadn’t been there to support me and speed things along, I probably would have gotten care,” Sharone told us. “But I don’t think I would have survived.”

Dr. Elaine Batchlor leads the award-winning MLK Community Healthcare in South LA and has been published in The Atlantic Ocean, The Washington Post And Los Angeles Times.

Dr. Medell Briggs-Malonson is chief of Health Equity, Diversity and Inclusion for the UCLA Health System and associate professor of emergency medicine at UCLA’s David Geffen School of Medicine.

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