Breast cancer more deadly for Native Americans

Observer Staff

11/12/2003 12:00:00 AM

FARMINGTON, N.M. (AP) -A year and three days ago, Anita Augustine got the shock of a lifetime when a mammogram revealed she had breast cancer.

"You never think it's going to happen to you. You hear about it, watch it on television shows, but I never thought it would happen to me," said Augustine, a petite 48 year-old Navajo woman with dark sparkling eyes. "I was very scared. I didn't know anything about it."

After the diagnosis, she immediately began researching breast cancer and treatment options on the Internet, staying awake until sunrise in an attempt to mitigate the uncertainty of her future with numerous Web sites.

After undergoing surgery, four chemo-therapy treatments and six weeks of radiation, not to mention the loss of her hair, all within the last 368 days, the mother of three grown children and one 6-year-old grandchild is cancer free.

Because of early detection, Augustine is one Native American woman who escaped joining a grim statistic.

Native American women are more likely than any other ethnic group to die from breast cancer, even though they are less likely than Anglo, black or Hispanic women to be diagnosed with the disease, according to figures provided by the New Mexico Breast and Cervical Cancer Detection and Control Program.

Moreover, Native American women diagnosed with breast cancer have a lower five-year survival rate than other ethnic groups.

Nellie Sandoval, a Native American woman and 15-year breast cancer survivor, said cultural barriers are largely to blame for the high incidences of death.

In Navajo the literal translation for cancer is "the sore that never heals." Sandoval said the translation leads Navajos to believe that a breast cancer diagnosis is a death sentence rather than an illness that can potentially be cured.

Breast cancer is also considered a forbidden subject because some Navajos believe speaking about the illness will actually cause the disease. Furthermore, Sandoval said some Native women may be embarrassed to talk about it or feel shameful conducting self-breast examinations.

"There are lots of cultural issues in terms of taboos, but embarrassment like that kills," Sandoval said. "The thing with cancer is, the longer it has to grow the more deadly it becomes. You have to talk about it."

It can also be difficult for those who live in remote places on the reservation without phone service or transportation to make and keep appointments.

Sandoval said there are also language issues. Navajo women with a poor command of the English language may have trouble communicating with doctors, which can lead to poor health choices.

She said she knew a Navajo woman named Rita who did not seek treatment after her breast cancer was diagnosed because she misunderstood the directions about the process.

"She thought they were going to slit her throat when they inserted the catheter. No one was there to explain it to her in Navajo and she didn't get treatment," Sandoval said. Rita eventually died of the disease.

"That's why I'm so outspoken," Sandoval explained. "Oh my God, I got 15 extra years of my life. Just think of what could have happened if I crawled into my home and never came out."

As part of an outreach effort, Sandoval and Augustine participated in the making of a video explaining breast cancer in the Navajo language called "Breast Cancer: The Healing Begins," a sequel to "Breast Cancer: It Can be Healed."

Both videos, which were sponsored by the San Juan Medical Foundation, are in Navajo with English subtitles.

The videos are available by calling (505) 324-6813.

"I wish I had seen something like that when I was diagnosed. You have to take care of yourself and you have to learn how to do it," said Augustine.

Noted Sandoval, "Because of the stage Native American women present to doctors, there's almost no hope. They key is early detection. That's where the most hope is and a chance for a cure."

Sandoval found the lump in her breast herself and after a mammogram failed to pick it up, she pushed for a biopsy.

"I believe in women's intuition. We need to listen to that too," she said. "I know it saved my life."

Although there is no known strategy to prevent breast cancer, early detection and treatment significantly increases the survival rate, according to the American Cancer Society.

The agency recommends women age 20 to 39 have annual clinical breast examinations by a doctor and do monthly breast self-examinations. Women 40 and older are encouraged to do the same, as well as have an annual mammogram.

Both Sandoval and Augustine said cancer has drastically change their outlook on life.

"I enjoy things more. I do more with my family. I hug people more. It has made me more emotional person, but in a good way, just everyday things. I have more gratitude and I'm more thankful for what I have," explained Augustine. Said Sandoval, "This is how I look at cancer _ it was a gift because it made me realize how precious my life is."