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Born in the Dominican Republic, 45-year-old Padilla, who lives in Washington Heights, is one of several volunteer promotoras (or health educators) trained to demystify breast cancer and bring culturally sensitive prevention messages to Latinas in the Washington Heights and Inwood communities. The pilot program was launched a few months ago by the American Cancer Society.
"When you have someone [who has breast cancer] that you know personally, rather than a billboard or someone on TV, it becomes more real," says Melissa Carlo, who manages the Latina breast health program at the ACS (hot line: 212-237-3814). "Digale a una amiga" ("Tell a friend") is the program's motto.
The incidence of breast cancer is rising faster for Hispanic women than for any other female ethnic group. Their mortality rates are lower than for African American or white women, but the five-year survival rate for Hispanic women is lower than for white women, because they are often diagnosed at later stages, when the disease is less treatable.
Cultural beliefs and socioeconomic factors can affect breast cancer outcomes. "Breast cancer was never spoken about because my grandmother and my mother are old-fashioned," says Padilla, whose left breast was removed five years ago. "In the Hispanic community, things become secretive. You don't say, 'I had cancer and I had my breast removed,' because it's not feminine."
Some Latinas subscribe to the Maria complex, a martyrlike notion that they should sacrifice their needs to everyone else's. "We take care of other people," says Carlo. "We don't take care of ourselves until we're at a stage where we can't walk." Others take a more fatalistic approach: "I am not afraid of cancer, because we all have to die of something. I am very committed to the Lord," said one woman during a recent focus group.
"In our community, there is a huge lack of information," says Nilsa Tavares, a 42-year-old thyroid cancer survivor who spreads the gospel of breast cancer prevention with fervor. "[Pamphlets are] always in my purse. I give them out in the beauty salon, in the pharmacy, in the supermarket."
Tavares, a Medicaid recipient, attributes Latinas' reluctance to seek health care services to a lack of medical insurance. The American College of Physicians and the American Society of Internal Medicine reports that 35 percent of the Hispanic population is uninsured. "It breaks my heart when a woman says, 'I have no insurance,' " says Padilla, who tells women where to find free or low-cost mammography. Undocumented women often don't seek health services. "They feel that if they go, immigration will find out that they're receiving services," says Carlo.
Iris Mendez, a 54-year-old Puerto Rican, is Bronx and Manhattan coordinator for "Reach to Recovery," a program that helps women with breast cancer. Mendez was diagnosed at age 47, after spotting a bloody discharge from her left nipple. "I try to encourage women [to get mammograms] anywhere I go," she says.
Many Latinas (especially older ones) don't do monthly breast self-exams because of embarrassment over touching their breasts in a way that seems like fondling, or won't get a mammogram because they have to disrobe in front of a stranger.
"I didn't actually start looking at myself and self-examining until I was diagnosed," admits Padilla. A year ago, a doctor found a precancerous lump on her right breast.
On Sunday, Padilla participated with her 17-year-old son, David, in the annual "Making Strides Against Breast Cancer" walk.
"My sons live with the fact that I have to go to the doctor, that I do drink my medicine," she says. "They've been aware since day one."