Why Did You Wait So Long?

Doctors in the breast health centers, where I navigated, would often refer a new patient to me immediately following informing her, or in rare cases him, of a breast cancer diagnosis.

Those patients presenting with a visibly obvious tumor or one easily felt in a breast self exam often were asked by the examining physician, "Why did you wait so long to see a doctor"? Many times when they reached me, crying and badly shaken, they would spontaneously share why they waited so long to get help.

Many of the patients were new immigrants with language barriers who had little knowledge of breast cancer, breast screenings and the need for regular check ups. Most came from countries where health care was a luxury and women sought medical attention when pregnant, in severe pain or seriously ill. Preventative medicine and early detection practices were foreign to them.

Some said they could not afford to take time from work without losing a day's pay. A few women shared that they could not get to the doctor since there was no one to take care of their young children during they day. Young women, with a new baby, said they thought the lump was something to do with nursing. Some had even checked it out with a doctors in neighborhood clinics who told them that they were too young for breast cancer and that it was probably a blocked milk duct.

Still others gave cultural or religious reasons for not seeking care until the tumor was obvious to the touch or could be seen. Some stated that they were not allowed to touch themselves and therefore didn't check their breasts. Others shared they were not permitted to be examined by a male doctor and did not know where a female doctor would be available to examine them. Some shared that their husbands decided when they could get medical care and until they were convinced the lump was growing, they did not give permission.

Others shared their fears about treatment; loss of hair, loss of a breast. What would their spouses or significant others do?

After every visit, I was left to wonder what it was going to take to reach women in communities that live apart from mainstream society and have them take advantage of free, accessible, breast health care while their cancers were still small enough for a more favorable outcome.

Many organizations provide literature in a variety of languages and do outreach in these communities, but more needs to be done. Any ideas?