Medical Barriers to Mammography Screening of African American Women in a High Cancer Mortality Area: Implications for Cancer Educators and Health Providers

Abstract

African American women have a higher breast cancer mortality rate than whites even when cancer subtype is considered, are more likely to be diagnosed at a later stage, and are less likely to have mammography screening. Structural barriers limit screening but may be less important than clinical care and personal barriers among minority and lower income women. A random sample of 178 African American females aged >40 years from a high cancer risk area was surveyed to associate mammography screening with clinical, structural, and personal barriers. Clinical barriers including patient education and communication were significantly associated with lack of screening in previous 2 years. Personal barriers (lack of trust and knowledge) and structural barriers (lack of insurance, facilities, and providers) also reduced screening. Results reveal that medical practitioners should be more pro-active in reducing clinical barriers to mammography screening among lower income African American women. Improved patient physician communication, education about breast cancer to build knowledge and reduce fears, referral for mammography, and building trust are indicated.

Barriers to screening mammography

“…Lack of an HCP recommendation was significantly associated with non-adherence in all 10 of the predictive studies that tested the significance of recommendation on adherence status (Calvocoressi et al, 2004;Juon et al, 2004;Lee-Lin et al, 2007;Levy-Storms et al, 2004;Liang et al, 2009;Lopez et al, 2009;Somanchi et al, 2010;Tang et al, 2000;Wang et al, 2009;Young et al, 2011). Furthermore, six identification studies cited lack of an HCP recommendation as a barrier to screening (Clark & Natipagon-Shah, 2008;Davis et al, 2005;Documét et al, 2008;Fernandez et al, 2005;Paskett et al, 2004;Tejeda et al, 2009).…”

“…A total of 31 studies were included in the review of barriers to screening mammography, including 17 predictive studies (Calvocoressi et al, 2004;Champion & Skinner, 2003;Elkin et al, 2010;Farmer, Reddick, D'Agostino, & Jackson, 2007;Gierisch et al, 2009;Juon, Kim, Shankar, & Han, 2004;Lee-Lin et al, 2007;LevyStorms, Bastani, & Reuben, 2004;Liang et al, 2009;Lopez, Khoury, Dailey, Hall, & Chisholm, 2009;Mack, Pavao, Tabnak, Knutson, & Kimerling, 2009;Schwartz, Fakhouri, Bartoces, Monsur, & Younis, 2008;Somanchi, Juon, & Rimal, 2010;Tang, Solomon, & McCracken, 2000;Wang et al, 2009;Wu & Ronis, 2009;Young, Schwartz, & Booza, 2011) and 14 identification studies (Ahmed, Fort, Elzey, & Bailey, 2004;Ahmed, Fort, Micah, & Belay, 2001;Buki, Borrayo, Feigal, & Carrillo, 2004;Clark & Natipagon-Shah, 2008;Davis, Emerson, & Husaini, 2005;Documét et al, 2008;Fernandez, Palmer, & Leong-Wu, 2005;Fowler, 2006;Gany, Herrera, Avallone, & Changrani, 2006;McAlearney, Reeves, Tatum, & Paskett, 2007;Moy, Park, Feibelmann, Chiang, & Weissman, 2006;Paskett et al, 2004;Peek, Sayad, & Markwardt, 2008;Tejeda, Thompson, Coronado, & Martin, 2009;Thomas & Usher, 2009;Watson-Johnson et al, 2011). Details about the samples, methodologies and barriers of the included studies are presented in Supplemental …”

“…Furthermore, six identification studies cited lack of an HCP recommendation as a barrier to screening (Clark & Natipagon-Shah, 2008;Davis et al, 2005;Documét et al, 2008;Fernandez et al, 2005;Paskett et al, 2004;Tejeda et al, 2009). Women are significantly less likely to be screened (ever, recently or regularly) if they have not received a recommendation from an HCP (Calvocoressi et al, 2004;Juon et al, 2004;Lee-Lin et al, 2007;Levy-Storms et al, 2004;Liang et al, 2009;Lopez et al, 2009;Somanchi et al, 2010;Tang et al, 2000;Wang et al, 2009;Young et al, 2011). The importance of a lack of HCP recommendation to screening non-adherence has been observed in Latina (Tejeda et al, 2009), African-American (Lopez et al, 2009;Young et al, 2011) and Asian-American (Juon et al, 2004;Lee-Lin et al, 2007;Liang et al, 2009) samples.…”

A systematic review of randomised controlled trials examining the effectiveness of breast and cervical cancer screening interventions for ethnic minority women

“…Although the incidence rate of breast cancer is approximately the same among all races/ethnicities, the mortality rate is higher among black women than other races (National Cancer Institute, 2014a). Research conducted in Western countries reveals that ethnic minority women are less likely to access cancer screening services and that they encounter more barriers than others: traditional customs, values and beliefs, perceptions of screening and vulnerability, physicians' attitudes, lack of cancer-related knowledge, language constraints, financial considerations, education levels, and familiarity with the local healthcare system (Ackerson and Gretebeck, 2007;Remennick, 2006;Young et al, 2011).…”

Breast cancer screening: The role of attachment

“…As cancer worry increases screening (Orom, Kiviniemi, Shavers, Ross, & Underwood, 2012), low worry, characteristic of secure and dismissive styles, may result in fewer screens among women with these characteristics. In turn, preoccupied and fearful avoidant styles are highly anxious, but while preoccupied persons seek help when distressed (Bartholomew & Horowitz, 1991) suggesting more screening, fearful avoidants, like dismissives, avoid interpersonal vulnerability, potentially screening less (Young, Schwartz, & Booza, 2011).…”