As Professor and Chief, Division of Clinical Cancer Genetics at City of Hope, Dr. Weitzel helped conduct the largest study to date confirming the high prevalence of BRCA mutations in the Hispanic population. He’s since been on a mission to raise awareness about breast cancer risk and prevention amongst these Latinas by understanding their cultural values – and then applying this knowledge to new intervention methods and approaches to risk assessment.

In part one of this interview, Dr. Weitzel first talks about the barriers that are holding Latinas back from taking preventative action and learning about the genetic aspect of their risk for breast cancer.

Glenn: Hello Dr. Weitzel. It’s good to talk with you again. I wanted to continue the discussion you started in your previous articles about the major deterrents you see that are keeping Latinas from taking more preventative action when it comes to breast cancer in the community?

Dr. Weitzel:  I think that many women, Latinas included, are not empowered enough to take preventative action because of the number of barriers that stand in their way. One of those barriers affecting Latinas in particular is the availability of preventative care; that is, are there enough skilled people in the medical community offering prevention as an option and enabling them to take advantage of that course of action?

For instance, with regards to genetic risk assessment and care, there have been many changes and advances that will allow us to take better advantage of new technologies and provide less expensive, wider access to the tools needed to evaluate and understand risk in the community, and take better care of the women most at risk.

Another barrier to prevention can be attributed to the fact that many Latinas have traditionally been under- or uninsured. Because they didn’t have access to healthcare coverage or couldn’t afford it, they didn’t always have information about and access to the healthcare they needed, including preventative care. The fact remains that many people still look upon preventative healthcare as a luxury, instead of the necessity that it is. In fact, it’s one of the soundest investments we can make when it comes to our immediate and future health. But prevention isn’t always top of mind when you’re already dealing with life’s daily challenges.  

Glenn: People think: Why go looking for more trouble? Is this way of thinking more prevalent in the Hispanic community because of the fear and fatalistic attitude many of us have or are taught growing up?

Dr. Weitzel: I would say it’s not so much fatalism as it is just a healthy dose of realism. Think about it: if I don’t have access to care, it’s just more realistic to accept not knowing about something that you don’t think you can do anything about or prevent anyway. We can try and look at it through a cultural lens, but at the end of the day it’s really more of a socio-economic issue and a realistic look at the limited resources and options people perceive they have available to them.

Fear is a common barrier amongst all populations, but more so when there is a lack of education and understanding as there has been in the Hispanic community. As soon as someone learns that care is accessible to them, and that it will make a difference – not just to themselves but to their families – that’s the day they start to take preventative action.  

Glenn: Do you think the disproportionate number of Hispanic doctors relative to the growing population is another barrier preventing Latinas from seeing a doctor and getting preventative care?

Dr. Weitzel: Certainly that is a common problem, not finding a familiar face wearing the white coat, or speaking the same language. Being able to communicate in the native language when necessary is especially important for a cognitive specialty like genetics, where so much is dependent upon obtaining a good family history and explaining somewhat complicated technology in lay terms.

On the other hand, it doesn’t have to be the barrier that we think it is. You don’t have to be Latino to enhance your cultural competence, learn more about the population, and tailor your care to them so that it’s more effective and they can make better use of it. With enough bilingual and bicultural counselors, clinicians and technicians, we have the ability to bridge cultural barriers, speak the same language, and work as a team to earn trust as “significant other” caregivers who are there to help, heal and prevent disease. Personally, I have seen the results of this pay off in many ways, most notably in the dedication to engagement that Latinas have once they start participating at our cancer risk counseling clinic.

Glenn: You mentioned the importance of earning trust. How hard is it to earn trust and loyalty from the community – and do physicians even have the time for it?

Dr. Weitzel: In general, it can be difficult for doctors to dedicate the time, or for patients to build trust in a 15-minute doctor visit. But for cancer risk counselors, we have the luxury of time – or at least the luxury of not having a choice. Working in a cognitive specialty, we know going in that we are not going to be effective unless we can get the most complete and accurate information about patients and their family histories with regards to cancer.

But it’s that process of engagement with patients and their families that also helps us to communicate with them more effectively – because we get the time to develop their trust and earn their respect. Even the most skeptical will come around once they know we have their best interests at heart – and those of their extended families.

In part two of this interview, Dr. Weitzel will discuss some of the work he and his team are doing to break down the barriers to preventative care, especially amongst Latinas who may have a genetic predisposition to breast cancer, and the most recent advances in intervention methods for risk assessment and testing.

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