Last summer, Jessica Rodriguez didn't want to go outside, or even open the door. She didn't want anyone to see she had lost her hair during breast cancer treatment.
Rodriguez, 39, said she found strength from the support of her husband and children, and through an organization called Nueva Vida, a support network for Latinas with cancer based in Washington. At support meetings, she met other women who had lost their hair in cancer treatment and realized she was not alone.
"They were going through the same," said Rodriguez, who moved to the United States from Peru 12 years ago and now lives in Germantown, Md. "I say: They're OK. It's only the hair. It's going to go grow back."
Some Latina breast cancer survivors such as Rodriguez have found comfort and assistance from organizations geared toward Hispanics. Nueva Vida and other groups are trying to address needs such as breaking language barriers, paying for treatment and finding support from others going through similar challenges.
Rodriguez said she didn't know how she could have paid for treatment without Nueva Vida. It introduced her to a Maryland state program that covered her surgery, chemotherapy and radiation.
"I may be not talking to you," she said. "I don't know. I don't think I could have made it without all the help."
What the statistics say
Cancer remains a major health problem among Hispanics, but statistics show they are at a surprising advantage compared with some other ethnic groups. Researchers are trying to figure out why.
In the United States, the death rate from all cancers among Hispanics is about 129 per 100,000 people per year, compared with 191 per 100,000 for whites and 239 per 100,000 for African-Americans/blacks, according to the National Cancer Institute. Breast cancer incidence and mortality specifically are also lower among Hispanics than whites or blacks, according to the American Cancer Society.
The figures are puzzling, given that Hispanics have a lower socioeconomic status on average than whites. Data from the Pew Research Center suggests the typical Hispanic household had $6,325 in wealth in 2009, while the typical white household had $113,149.
Even more curiously, a 2013 study in the International Journal for Equity in Health found that, among Hispanics in Texas, mortality rates for several cancers, including breast cancer, tend to be lower among those with more socioeconomic deprivation. A low mortality rate does not correspond with low socioeconomic status in whites and African-Americans, the study found. More research needs to be done to confirm these findings.
The phenomenon associating Hispanics with better health outcomes despite lower average income and education rates is called the "Hispanic paradox." A possible explanation for this trend is that smoking is much less common among Hispanics than non-Hispanic whites or African-Americans, according to the Centers for Disease Control and Prevention.
Another theory is that people who immigrate to the United States tend to be healthier than those who stayed in their home countries. It's also possible that some who get sick return to their home countries.
Despite slightly better statistical odds of not getting cancer than whites or blacks, Hispanics are not immune to these conditions, and breast cancer kills more Hispanic women than any other cancer.
More often in Hispanics than whites, breast cancer is detected at an advanced stage, according to the American Cancer Society.
A 2013 study in the journal JAMA Surgery focusing on young women with breast cancer, ages 15 to 39, found that the time between diagnosis and treatment of breast cancer differed significantly depending on the ethnicity of the participants. Researchers found that about 15% of Hispanic and African-American women waited more than six weeks for treatment, compared with 8% of non-Hispanic white women. Longer waiting periods are linked to shorter survival time, the study found.
Dr. Mariana Chavez MacGregor, breast oncologist at MD Anderson Cancer Center in Houston, said she believes that access to health care is partly responsible for the later detection of breast cancer in Hispanic women.
"If people have no health insurance, doing a test for something you don't even have, it's really at the bottom of the list," she said.
There are also, she said, "probably cultural reasons in which we may have more difficulty dealing with this and seeking medical attention."
What survivors say
Research is ongoing to narrow down the best ways to improve the quality of life among Hispanic breast cancer survivors and their caregivers. Nueva Vida is participating in a research project led by Kristi Graves at Georgetown University to figure out the best approaches.
The issues that tend to arise among Hispanic women who have breast cancer aren't unique to Hispanics, and it is impossible to generalize across individuals; there are also many cultures that fall under terms such as "Hispanic" and "Latina." Nonetheless, Graves and researchers have picked up on some themes that often arise.
"Breast cancer isn't always talked about in Latino families," Graves said. "In some of these families, when you mention cancer it's considered synonymous with death."
Some survivors Graves has spoken with didn't tell their families about the cancer diagnosis until they had to start chemotherapy, because they didn't want to worry them.
"For some of the women, when they did start talking about cancer, they were really pleasantly surprised at the amount of support and information that they received," Graves said.