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How to advocate for your health as a woman of color

In 2020, some of the darkest struggles facing people of color were brought to center stage. For many, it was shocking. For those who live the day-to-day struggle of being treated differently because of their skin color, these events came as no surprise. It was a calling to raise our collective voices and join the fight.

In the face of discrimination, equitable access to healthcare can be exhausting and discouraging, but there is power in our voices. And when we use our voices and advocate for ourselves and each other, we can save lives.

Unfortunately, the healthcare system is not immune to racial and ethnic inequities. For example, black and white women are diagnosed with breast cancer at the same rate, but black women are 40% more likely to die from the disease than white women.  Regardless of your skin color, you deserve to receive the best care and have all of your questions answered.

If you’re not sure how to start, here are a few ways to advocate for your health: 

Understand your health insurance

Review your insurance policy to determine which doctors are in and out-of-network, how much copays and deductibles are, and what services are covered. This will help you navigate the healthcare system and reduce the probabilities of ending up with costly and unexpected medical bills. If you don’t have health insurance, there are low-cost ways to get health screenings.

Find a trusted healthcare provider

To find a healthcare provider you can trust, identify what is most important to you. Answering these questions give you a good start for your research and increase the chances of finding someone you can trust: 

  • Do you have a gender preference? 
  • Is the race/ethnicity or language of your provider important to you? 
  • Do your friends, family, or colleagues have a provider they recommend?
  • Is the provider’s location accessible to transportation, parking, shuttle service? These seemingly small things can help decrease your stress before going into the appointment.
  • Does your provider have an online bio? You’ll find information on their experience, interests, awards, and more.

Trust your intuition and be assertive

You know your body best. If you feel something is wrong, share your concerns with your provider. Ask them what their plan is to assess your symptoms and address your concerns. Ask what tests will be done and how you will receive your results. 

Ask questions

Before you visit your provider, prepare a list with your questions and concerns. There are no dumb questions! Take notes during and after your visit, and follow up if you need more information. Also, consider bringing a friend or family member to take notes or to help advocate for you. Ask your provider if they would be okay with you recording the visit so you can review it later.

Get a second opinion 

If you do not feel confident and comfortable with your provider’s diagnosis and/or treatment plan, don’t hesitate to find a second opinion. You should feel confident that you have made the best decision for your health.

Maintain your own records

Keeping a record of the dates and notes from each appointment can be useful to look back on, especially if you switch insurances or seek a second opinion.  

Find a supportive community

We are stronger together and others’ experiences can help you discover the right path for you. If you may be at high risk for ovarian or breast cancer, the Rivkin Connect program is here to help you connect with other high-risk individuals who have already navigated this path and have taken many different approaches to breast and ovarian cancer prevention

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Talk to your Family

Talking to your family and identifying cancer in your family tree can be a good indicator of your health risks. Download our Family Tree Worksheet here.  Be sure to include yourself, children, parents, siblings, aunts, uncles, and grandparents.

Get Educated

Know your body and be proactive about your health. Learn about your breast and ovarian health. Learn about the risk factors and signs & symptoms for breast and ovarian cancer.

Trusted Healthcare Provider

Having a relationship with a health care provider you know and trust is one of the most important decisions you’ll make about your health care. Click here to find a provider

Higher Risk in the Ashkenazi Jewish Population

In the general population, around 1 in 400 people carry a BRCA1 or BRCA2 mutation. People of Ashkenazi Jewish ancestry have a 1 in 40 chance of carrying a BRCA mutation, making them 10 times as likely to carry a BRCA mutation as someone in the general population. Whether you’re a man or a woman, if you have a BRCA mutation then there is a 50% chance of passing the mutation on to your children, whether they are boys or girls. It’s important to note that these mutations significantly increase risk, but are not a guarantee a person will get cancer.

Why is the Ashkenazi Jewish population at higher risk?

Over 90% of the BRCA mutations found in the Jewish community are one of three “founder mutations”. A founder mutation is a specific gene mutation in a population that was founded by a small group of ancestors that were geographically or culturally isolated. Because the population was isolated, the rate of founder mutations in descendants is much higher than it would be if the population were larger and co-mingling with more genetically diverse populations. A large expansion in the population caused the current high frequency of the mutations in the Ashkenazi Jewish population. If you are of Ashkenazi Jewish ancestry, the chance of carrying a BRCA gene mutation compared to the general population is increased tenfold. BRCA mutations can be passed down from either your mother’s or father’s side, and may be associated with any of the following cancers:
  • Breast cancer
  • Ovarian cancer, fallopian tube, peritoneal cancer
  • Male breast cancer
  • Prostate cancer
  • Pancreatic cancer
  • Colon Cancer

Ready to take action? Knowledge is power. Take this short quiz to be proactive about your health.

Genes 101

Our bodies are made of many tiny building blocks called cells. Our cells contain a copy of our genome – all of the DNA genetic code we inherited from our parents. Our genome is organized into 46 chromosomes, 23 inherited from mom and 23 from dad. Each chromosome has hundreds or thousands of genes. Each gene has the instructions to make a protein that may control the structure or function of cells, can determine many things including how tall we are or the color of our eyes. Genes also contain instructions for many things inside of us that we cannot see, such as how our bones are formed or how our heart works. Each gene is made up of molecules called nucleic acids (A, T, C, and G). The specific sequence of the nucleic acids holds the instructions that control all the components and their functions in cells.

If the DNA sequence is changed, like a spelling mistake, the instructions may not make sense. The technical term for this change is “mutation,” meaning there is a change to the usual genetic code that may change the instructions stored in the gene. A mutation in a gene that repairs DNA damage or controls cell growth can increase the risk of developing cancer.

Sporadic vs Hereditary Cancers:

Ovarian and breast cancer can be either sporadic or hereditary. Sporadic cancers make up the vast majority (85-90%) of ovarian and breast cancers and are not associated with family history of either cancer or inherited cancer-associated mutations. Sporadic cancers arise from genetic mutations acquired in some cells of the body by events part of normal metabolism and environmental factors. This type of cancer can happen to anyone. Most acquired gene mutations are not shared among relatives or passed on to children.

Hereditary (also known as inherited, or familial) cancers are those that occur due to genetic mutations that are inherited from mom or dad. Other blood relatives may also share these same gene mutations. Parents give one copy of each gene to their children. If a parent has a genetic mutation in a gene, each of their children have a 50% chance of inheriting that mutation. Therefore, even in families with hereditary cancer, not all family members inherit the mutation that is causing cancer, and their risk of cancer is similar to the average person in the general population. Individuals who are suspected to have a family history with high incidence of ovarian, breast, and other cancers may be offered genetic testing to try to find the specific genetic mutation that may put them at risk. Importantly, individuals who do not have a known genetic mutation but have high incidence of ovarian, breast, or other cancers in their families are still considered at higher risk for developing those cancers.

Hereditary cancers often occur at an earlier age than the sporadic form of the same cancer, so experts often recommend starting cancer screening at a younger age for individuals at high risk for hereditary cancer. Hereditary cancers can also be more aggressive than the sporadic form of the same cancer. Individuals who have inherited a gene mutation may be at a higher risk for more than one type of cancer.

BRCA 1 and BRCA 2: Most Common hereditary breast and ovarian cancer

The genes that are most commonly involved in hereditary breast and ovarian cancer (HBOC) are BRCA1 and BRCA2. These genes are named for their link to breast (BR) cancer (CA), but they are also linked to ovarian cancer risk as well as other cancers. Both women and men can inherit mutations in these HBOC genes. BRCA1 and BRCA2 are tumor suppressor genes that have a usual role in our body of providing instructions on repairing DNA damage and preventing cancer. When a family has an inherited mutation in BRCA1 or BRCA2, this leads to an increase in cancer risk. Not every man or woman who has inherited a mutation in the BRCA1 or BRCA2 gene will develop cancer, but people who have a mutation do have a significanlty increased chance of developing cancer, particularly cancer of the breasts or ovaries.

While breast and ovarian cancers are the most common cancers diagnosed in people with BRCA1 and BRCA2 mutations, the risk of some other cancers is also increased. Men with BRCA1 and BRCA2 mutations have a higher risk of early-onset prostate cancer than men without mutations in either gene. Other cancers seen at increased rates, particularly in individuals with BRCA2 mutations, include pancreatic cancer and melanoma. Researchers are continuing to find new genes that are involved in hereditary breast and/or ovarian cancer so it is important to follow up with a genetic counselor on a regular basis if hereditary breast and ovarian cancer is likely in your family.

Talk to your family about your health history and take the Assess Your Risk quiz here

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