Racial differences, poverty linked to mammography use
COLUMBUS, Ohio – Better detection and treatment are helping to reduce death from breast cancer in America, but poor, rural and minority women – especially Native Americans – face barriers that keep them from taking advantage of cancer screenings that could potentially save their lives, researchers say.
The new study, to be published Dec. 1 in the journal Cancer, will appear online Oct. 25 in the Cancer newsroom at http://www.interscience.wiley.com/cancer-newsroom.
Electra Paskett, director of the Center for Population Health and Health Disparities at the Ohio State University Comprehensive Cancer Center, led a team of scientists at Ohio State and the Wake Forest University School of Medicine in studying hundreds of women in Robeson County, N.C. The area is one of the poorest in the state, and is home to the largest concentration of Native Americans east of the Mississippi River.
In trying to identify a way to increase use of mammography among poor, rural women over age 40, researchers surveyed 897 women (33 percent African American, 41 percent Native American, 25 percent white) about their knowledge, attitudes and behaviors regarding breast and cervical cancer screening.
The women – selected from patient records at a major area health care provider – were all identified as needing a mammogram.
Researchers discovered that overall, the women had poor knowledge about cancer screening. For example, when asked to identify a way to test for breast cancer, 43 percent of the sample was not able to name or describe a mammogram. An even greater number, 53 percent, could not identify a Pap smear as a way of detecting cervical cancer. Significantly fewer Native Americans (52 percent) and African Americans (54 percent) were able to mention or describe these procedures when compared to white women (70 percent).
Paskett says studies have shown that clinical breast exams coupled with annual mammography can significantly reduce death from breast cancer in women over age 50. Despite the fact that an increasing number of women are using screening mammography, estimates indicate that only about 41 percent of women in that category are getting screened annually, about half the stated national goal of 80 percent.
Although a large majority of the women in the study said they had had at least one mammogram during their lifetime, only 58 percent said they had received one in the past three years.
Many study participants, especially minorities, said money was an issue. Results showed 22 percent of whites said they did not have insurance, compared to 27 percent of African Americans and 32 percent of Native Americans. Interestingly, less than 11 percent had heard of the federally supported Breast and Cervical Cancer Detection Program in Robeson County that was available to help them pay for screenings.
In addition, many women cited pain, embarrassment and perceived danger from radiation as main reasons they did not get mammograms.
Finally, most of the women reported that their doctor did not prompt them to get screened for breast cancer. Three-fourths of the women said they had been to see a doctor during the past year, but two-thirds of them said that their physician hadn't encouraged them to have a mammogram.
Paskett sees these "missed opportunities" for intervention as problematic.
"Women in this area are clearly underutilizing available resources, and this study helps us understand some of the reasons why. At the same time, however, we clinicians have to make sure we are doing everything we can to help them get the services that will help them."
Generally, white women in the study were more likely to have health insurance, higher incomes, more education and to be married or living with a partner than the minority women. White women, more frequently than the others, mentioned that finding the time to be screened was a major problem.
Paskett says the study sheds new light on the behavior of Native American women, an important minority group that has not been included in research studies in the past.
"We found that Native American women have the lowest education levels, and that they are the least likely to be insured. They also had the highest perceived risk of breast cancer and displayed more worry about getting breast cancer but had the least knowledge about the disease when compared to the other women in the study."
She says these findings, and others, should be useful in designing future inventions to improve cancer screening among all groups.
Co-authors of the study include Cathy Tatum, Marisa Bittoni and Stephanie Dickinson at Ohio State, and Robert Michielutte, Ronny Bell, Kristie Long Foley and Julia Rushing from Wake Forest.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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