Abigail George is a senior at Austin College, studying Biology and Non-Profit Organizations. She is very passionate about women’s health and social justice. Abigail has been an intern for the AiRS Foundation in hopes of learning about the effects of breast cancer on body image and recently submitted the following research article.
According to the Breast Cancer Facts and Figures for 2022-2024 published by the American Cancer Society, breast cancer is the leading cause of cancer death in women worldwide. In the U.S., 1 in 8 women will be diagnosed with some form of invasive breast cancer in their lives. Although breast cancer does not only affect women, genetic women are at the highest risk of developing breast cancer. Additionally, due to the various health disparities in the U.S., low-income and rural women are at the highest risk of developing more invasive breast cancer diagnoses1,2. Although many women diagnosed with breast cancer may not consider themselves low-income before a breast cancer diagnosis, the additional financial strain breast cancer treatment requires will leave all individuals diagnosed with breast cancer in a financially vulnerable situation; however, financial vulnerability is highlighted in individuals who were previously low-income. Additionally, because women are at a higher risk of being low-income due to their roles as caregivers or the lack of equal pay, a cancer diagnosis creates increased income insecurities3.
In this study, five breast cancer survivors participated in a semi-structured interview where they answered questions about body image, femininity, sexuality, and relationships. Their answers revealed a monolith of information surrounding how low-income and rural women are affected by breast cancer. Participants explained how their lack of healthcare access due to socioeconomic status (SES) and environment exacerbated typical issues associated with a breast cancer diagnosis. Body insecurities are perhaps the most visual aspect of a breast cancer diagnosis. Women will experience hair loss, the loss of breast tissue, scarring, the lack of nipples, and even weight changes due to chemo. Breast cancer causes so many bodily changes it is no wonder women endure many insecurities following treatments. And in a society that has placed many stipulations on what a feminine body is, these body insecurities then bleed into issues of femininity. One woman explained how, post-mastectomy, she no longer felt like a woman because she could no longer comfortably fit into traditionally feminine clothing. Another highlighted how when she first received her implants post-reconstruction, she struggled to accept her new breasts as part of her. To many of you reading this, these are not unfamiliar thoughts. You may have even had these thoughts yourself. All women diagnosed experience body insecurities but being low-income or coming from a rural area denies breast cancer patients adequate access to reconstruction surgery.
While many heated debates can ensue on whether women should place their femininity within their physical appearance, the reality is that many do. In an interview with a plastic surgeon in the DFW area, they stated that receiving reconstruction surgery is a crucial yet overlooked aspect of breast cancer treatment. Data analyzing the quality-of-life assessments of patients who received breast reconstruction surgery versus those who had not or received delayed reconstruction support this statement4. Patients of the non-reconstruction group initially scored higher in perceived body image, psychosocial factors, and physical well-being; however, they decreased in these three areas and sexual well-being4. These results further indicate the importance of reconstruction surgery in the holistic treatment of breast cancer patients. Although the data has shown that reconstruction surgery is a vital part of breast cancer treatment, financial difficulties, familial responsibilities, or distance can act as barriers against surgery. While laws have passed ensuring women receive reconstruction surgery through insurance, those without insurance are still disadvantaged. Data shows that uninsured individuals tend to be low-income or live in non-urban environments, putting low-income women in rural areas at a higher risk of not receiving reconstruction surgery due to financial reasons5. Because of the financial burden reconstruction surgery has, those without insurance may opt out of reconstruction surgery. Financial difficulties also limit the type of reconstruction surgery a woman receives. For those without insurance, any tissue-based reconstruction is out of the question despite evidence indicating higher patient satisfaction in women who underwent a flap reconstruction6. Financial obligations even limit the type of implant a woman may get. According to the interviewed plastic surgeon, using an acellular dermal matrix (ACM) like Alloderm can have many benefits for patients receiving a breast implant. However, the FDA has not yet approved ACMs for breast reconstruction, so women who want to receive this treatment must pay out of pocket. For a woman who is low-income, this additional cost is inconceivable.
All financial issues aside, access to reconstruction surgery is further hindered by the time the process takes. While surgery and recovery are not things to be rushed, understanding that women in rural areas often drive hours for appointments highlights an additional obstacle in receiving reconstruction surgery. A lengthy reconstruction journey is not feasible for women who work or are the primary breadwinners of their families. Especially for low-income women, taking off from work for multiple doctor’s appointments and recovery means choosing between financial security for their family and their mental well-being. Two women interviewed had successful breast reconstruction, and both described their difficulties getting to appointments due to living in rural areas. Again, while surgery and recovery require many steps to ensure a healthy patient, rural women should have better access to providers within their vicinity. These interviews exposed that all barriers to reconstruction surgery are only further emphasized in women who are both low-income and living in rural areas. Indicating that women who fit this intersectional identity be treated with the proper care and consideration by their providers as their financial and living situation creates additional difficulties in treating their cancer but also their mental health through reconstruction surgery. Regardless of socioeconomic status or environment, all women deserve easily accessible breast cancer treatment and reconstruction. This study emphasized how low-income and rural women do not have the same access as other women, resulting in increased body insecurities that could be avoided with better reconstruction access. Increased accessibility requires policy change and modifications to the healthcare system to enact long-term solutions and decrease the existing inequalities in the American healthcare system. While organizations like AiRS are working to bridge the gap and ensure equal access to reconstruction surgery for all women, the need for these services only highlights how low-income or rural women are further disadvantaged by a breast cancer diagnosis. Reconstruction is such an important aspect of the recovery process and is a valid option that all breast cancer survivors should have.
