Beyond Access: Barriers To Screening Mammography Among Minority Women Include Psychological Factors

American Cancer Society
Monday, 26 April 2004

Personal cognitive and emotional experiences may provide a more useful explanation of minority women's generally poor utilization of screening mammography than the broader, more abstract categories of "culture" and "ethnicity." A new study published April 26, 2004 in the online edition of CANCER, a peer-reviewed journal of the American Cancer Society, represents the first large-scale, comprehensive investigation of multiple variables and their individual influence on breast cancer screening in minority communities. The results of the study will be available via Wiley InterScience, and will appear in the June 1, 2004 print issue.

Prior research has shown that minority women are less likely get screening mammograms compared to Caucasian women. Explanations for this disparity have largely focused on cultural differences between European and African Americans as well as on socioeconomic status. However, a growing body of evidence shows that individual attitudes and emotional factors also influence mammography rates, but these studies have been small and limited to predominantly Caucasian women.

A team of researchers led by Drs. Carol Magai and Nathan Consedine of Long Island University and Alfred Neugut of Columbia University's Herbert Irving Comprehensive Cancer Center interviewed 1364 women (50-70 years old) to test the relative contribution of demographic and socioeconomic factors as well as individual psychosocial factors, including health beliefs, perception of personal risk, cancer beliefs, and emotions such as embarrassment and stress, to screening mammography. The study was supported by the National Institutes of General Medical Science and the National Cancer Institute.

The study found U.S.-born African Americans and Dominicans were as likely to be screened as Caucasians; however, screening rates for English Caribbean, Haitian and immigrant Eastern European women remained lower than that of Caucasians.

The researchers found health and cancer beliefs as well as emotional attitudes impacted screening rates even when classic factors such as ethnicity and socioeconomic status were controlled. For example, women who believed cancer is caused by a bruise or sore and that conventional treatments may be worse than the disease were less likely to be screened. Additionally, emotional factors such as stress and embarrassment strongly and negatively impacted mammography use.

Perhaps most important, ethnicity was a poor predictor of mammography utilization once psychological factors were taken into account. According to Magai and colleagues, that may suggest differences in screening among various ethnicities are related to differences in attitudes, beliefs, and emotions surrounding breast cancer screening. Consequently, they say, "interventions designed to increase screening mammography among minority women might be more profitably aimed towards modifiable cognitive beliefs and emotional experiences pertaining to mammogram utilization, rather than towards less mutable background characteristics such as education or income."

Article: "Diversity Matters: Unique Populations of Women and Breast Cancer Screening," Carol Magai, Nathan Consedine, Francine Conway, Alfred Neugut, Clayton Culver, CANCER; Published Online: April 26, 2004 (DOI: 10.1002/cncr.20278); Print Issue Date: June 1, 2004.

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