The story of breast cancer in Hispanic women or Latinas is one that has not been fully told or investigated. Overall, breast cancer rates in this population are 28% lower than in non-Hispanic white women — but that doesn't give the complete picture.
Because of health disparities that prevent access to adequate and affordable health care, breast cancer in Latinas and Hispanic women may remain undiagnosed until later stages when it is more difficult and expensive to treat. That's one reason Hispanic women and Latinas are about 30% more likely to die from their breast cancer than non-Hispanic white women. They are also at higher risk for triple-negative and human epidermal growth factor receptor-positive breast cancers, which are more aggressive than other types of breast cancer.
UC Davis Comprehensive Cancer Center wants to improve the detection and survival odds of Hispanic women and Latinas by seeking them out in the community and connecting them to resources for prevention, screening and treatment of breast cancer.
Tu Historia Cuenta, which in Spanish means "your story matters," is the name of a new program led by Laura Fejerman, co-director of the cancer center's new Women's Cancer Care and Research Program (WeCARE). The project examines hereditary breast cancer risks and screening in Hispanic women and Latinas in Northern and Southern California and provides family risk assessment and navigation to services.
Fejerman, who is also co-director of the cancer center's Latinos United for Cancer Health Advancement or LUCHA, said that Latinas are less likely to seek genetic counseling or testing for breast cancer compared to non-Hispanic white women. They also have lower rates of mammography screening.
"Low-income Latinas are getting left behind because they are not aware of the role genes play in breast cancer and, if they become aware, often they don't have access to genetic counseling and testing," said Fejerman.
Inspired by and in partnership with Ysabel Duron, a Latina advocate and founder of The Latino Cancer Institute in San Jose, Fejerman designed a specific program that focused on hereditary breast cancer as a community partnership. Health educators known as "promotores" are trained to educate Latinas about how to access resources for breast cancer screenings and treatment.
Fejerman said UC Davis Comprehensive Cancer Center wants to better serve Hispanic and Latino cancer patients and their families, and that starts by developing community relationships that can overcome language and cultural barriers. Promotores conduct outreach in Spanish and spend about an hour with talking with individual Latinas.
During the COVID-19 pandemic, the program began conducting hereditary breast cancer education sessions in Spanish via Zoom so that progress could continue despite social distancing safeguards.
The California Initiative to Advance Precision Medicine, part of the Governor's Office of Planning and Research, is funding Tu Historia Cuenta, which UC Davis, UC San Francisco and City of Hope are operating collaboratively.
Fejerman said Tu Historia Cuenta is the first step in reducing health disparities and addressing the breast cancer burden that exists currently in the Hispanic and Latino community.
I like the idea of helping women like me, educating them and building relationships while connecting them with resources that give them access to care."-Maria Gonzalez.
Meet a promotora
Maria Gonzalez is a promotora — a community health educator. The Centers for Disease Control and Prevention recognizes promotores de salud, also known as promotoras, as important lay health workers who are trusted and empowered to educate and connect their peers to information and resources that can save lives.
"Maria represents the people she is trying to help," said Fejerman, who depends on Gonzalez and three other promotores in the Sacramento and San Francisco areas to conduct outreach among Hispanic women and Latinas as part of her Tu Historia Cuenta breast cancer project.
Gonzalez, 49 and a mother of five, knows the importance of connecting her family, friends and neighbors to resources that keep them healthy. She first helped other parents with special-needs children navigate access to resources, including those provided by the UC Davis MIND Institute after receiving care for her child at the research and treatment center for neurodevelopmental conditions.
Now, after battling breast cancer eight years ago, Gonzalez works for an agency called Visión y Compromiso that was contracted by the Tu Historia Cuenta program. She was trained to educate members of her community about hereditary breast cancer and navigate them to screening services.
"I like the idea of helping women like me, educating them and building relationships while connecting them with resources that give them access to care," said Gonzalez.
One of those programs is the state-funded Every Woman Counts screening service, providing mammograms free of charge to underserved women. Typically, Gonzalez connects with 15 to 20 women a month, speaking in Spanish to them via Zoom meetings set up in advance.
Gonzalez makes presentations at churches, schools and community group meetings, where she registers women for classes. Through Fejerman, who translates her Spanish into English, Gonzalez said she doesn't usually have to initiate contact with community members. Women typically find her because she is well known in the community and considered a key intermediary to health care resources.
"Mainly, people know me through word-of-mouth," said Gonzalez. "People are coming to me already to get health information."
Identities of the women whom Gonzalez interviews are kept private.
"Gonzalez is a crucial link in growing the trust network in our community," Fejerman said. "I feel we will finally make progress in addressing the cancer burden in Hispanic and Latino communities by leveraging promotores such a Gonzalez who have a strong passion and a commitment to healthier communities."
