Epistemic injustice and age-based disparities in young women with breast cancer in Chile
Abstract
Background Breast cancer in young women presents distinct clinical and psychosocial challenges, yet healthcare systems remain organised around older age groups, shaping how symptoms and concerns are recognised. These patterns of non-recognition can be understood through the framework of epistemic injustice, which examines how credibility and interpretive resources are differentially distributed in healthcare encounters. Objectives This study examines how epistemic injustice operates across the experiences of young women with breast cancer, focusing on diagnosis, treatment, and survivorship. Design Qualitative study based on in-depth semi-structured interviews. Methods This study draws on a purposive sample of 28 women diagnosed with breast cancer before the age of 40, interviewed within six years of diagnosis in the Metropolitan Region of Chile. Interviews were analysed using reflexive thematic analysis, informed by the framework of epistemic injustice and guided by explicit criteria distinguishing epistemic injustice from service deficiency. Results Epistemic injustice emerged as a temporally structured process unfolding across the cancer trajectory. In diagnosis, women’s symptoms were frequently dismissed through age and gender-based credibility biases, a pattern consistent with testimonial injustice. In treatment, a strong focus on survival marginalised concerns related to fertility, sexuality, and identity, reflecting hermeneutical injustice arising both where clinical frameworks were absent and where available frameworks were nor applied. In survivorship, expectations of full recovery left ongoing disruption difficult to articulate, a further form of hermeneutical injustice operating through dominant recovery narratives. Across all phases, age functioned as a shifting epistemic filter shaping how women’s experiences were interpreted and acted upon. Conclusion Epistemic injustice in early-onset breast cancer unfolds across the full illness trajectory and was observed in accounts from both public and private settings. Addressing these inequities requires attention to how age shapes clinical interpretation and care models that recognise young women’s experiences as clinically relevant.
Related
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BibTeX
@article{sadler2026epistemic,
title = {{Epistemic injustice and age-based disparities in young women with breast cancer in Chile}},
author = {Michelle Sadler and Alexandra Obach and Baltica Cabieses},
journal = {Women's Health},
year = {2026},
month = nov,
doi = {10.1177/17455057261504066},
url = {https://doi.org/10.1177/17455057261504066},
note = {CC BY},
}
RIS
TY - JOUR
TI - Epistemic injustice and age-based disparities in young women with breast cancer in Chile
AU - Michelle Sadler
AU - Alexandra Obach
AU - Baltica Cabieses
PY - 2026
DA - 2026/11/07
JO - Women's Health
DO - 10.1177/17455057261504066
UR - https://doi.org/10.1177/17455057261504066
AB - Background Breast cancer in young women presents distinct clinical and psychosocial challenges, yet healthcare systems remain organised around older age groups, shaping how symptoms and concerns are recognised. These patterns of non-recognition can be understood through the framework of epistemic injustice, which examines how credibility and interpretive resources are differentially distributed in healthcare encounters. Objectives This study examines how epistemic injustice operates across the experiences of young women with breast cancer, focusing on diagnosis, treatment, and survivorship. Design Qualitative study based on in-depth semi-structured interviews. Methods This study draws on a purposive sample of 28 women diagnosed with breast cancer before the age of 40, interviewed within six years of diagnosis in the Metropolitan Region of Chile. Interviews were analysed using reflexive thematic analysis, informed by the framework of epistemic injustice and guided by explicit criteria distinguishing epistemic injustice from service deficiency. Results Epistemic injustice emerged as a temporally structured process unfolding across the cancer trajectory. In diagnosis, women’s symptoms were frequently dismissed through age and gender-based credibility biases, a pattern consistent with testimonial injustice. In treatment, a strong focus on survival marginalised concerns related to fertility, sexuality, and identity, reflecting hermeneutical injustice arising both where clinical frameworks were absent and where available frameworks were nor applied. In survivorship, expectations of full recovery left ongoing disruption difficult to articulate, a further form of hermeneutical injustice operating through dominant recovery narratives. Across all phases, age functioned as a shifting epistemic filter shaping how women’s experiences were interpreted and acted upon. Conclusion Epistemic injustice in early-onset breast cancer unfolds across the full illness trajectory and was observed in accounts from both public and private settings. Addressing these inequities requires attention to how age shapes clinical interpretation and care models that recognise young women’s experiences as clinically relevant.
SN - 1745-5065
ER -