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Breast Cancer: Death Rate Remains Higher Among African American Women February 17, 2009

Posted by Carolyn Watson in Health Communications & Marketing, Prevention.

The overall death rates from breast cancer in the United States has dropped, but not among African American women.  In a study conducted by the American Cancer Society, researchers examined data from the National Center for Health Statistics (NCHS) for years 1975 through 2004, by state and race. 

The study found that in 1991 breast cancer death rates among African American women were 18% higher than among Caucasian women.  Although incidence rates for breast cancer is consistently lower among African American women (than in their Caucasian counterparts), the study found by 2004, death rates from breast cancer had increased 36 percent higher among African American women than among Caucasian women.  

A primary reason for the disparity is African American women tend to be diagnosed at later stages of disease.  Early diagnosis is critical to cancer survival.  Therefore, lower rates of mammography put African American women at higher risk for late-stage cancer diagnosis. 

There are several barriers to mammography screening among African American women including:

Access to clinical breast exams and mammography screening:  In some geographic regions of the country, particularly rural areas, low-income African American women continue to have less access to mammography and lower quality screenings.  Although great strides have been made in terms of equalizing access to mammography screenings (i.e., through mobile units and increasing the number of screening sites), many women are simply not utilizing the services being provided.

Knowledge, cultural attitudes, and beliefs:  Cultural and religious beliefs among many African Americans can influence decision-making regarding health behaviors and disease treatment.  Studies show a correlation between fatalistic thinking and lower prevalence of mammography screening among African American and other minority women.  The extent to which such beliefs exist, however, may be generational or denomination-based (as similar beliefs occur among various other racial and religious groups.)  Fatalism in terms of cancer is based on the thought that having cancer will inevitably result in death.   An example of fatalism is the belief that God will heal an individual of disease without any action on his/her part.  Euphemisms that represent fatalistic thinking are phrases such as “Leave it in God’s hands,” and “I will die if its my time to go.”  Holding such beliefs essentially absolves an individual from taking personal responsibility for improving his/her condition.  

Fear:  Fear can occur as a result of having insufficient and incorrect information.  That is why “improving knowledge of breast cancer screening” is central to the CDC’s new breast cancer initiative, African American Women and Mass Media Campaign (AAMM).  As reported in the Science Daily, U.S. researchers at Western Michigan University concluded

“…fear could motivate women to either seek screening or avoid screening.”  

A common response to experiencing fear is “fight or flight.”  In terms of mammography screening, a woman who experiences (or anticipates experiencing) pain or discomfort during screening or is fearful of test results (having breast cancer) will either confront the problem by getting screened/rescreened  (fight) or practice denial and not receive breast screening (flight).   

Self-efficacy:  In the context of mammography screening, a woman is more likely to have a mammogram performed if she understands the procedure and believes she is capable of handling the screening results (possible diagnosis of breast cancer) and next steps.  Conversely, a woman is less like to have a mammogram if she does not understand the significance of the procedure and is not confident in her ability to navigate medical treatment or cope with fear of death. 

Other considerations:

Socio-economic factors can influence the decision-making process (directly and indirectly) for mammography screening among African American women.  For low-income house holds of all races, even minor changes in  family expenses can reduce the ability to meet basic needs.  Therefore,  concerns such as childcare and job security (fear of job loss due to illness) are chronic sources of anxiety.  This suggests, low- and middle-income African American women (as well as women of other racial groups) might be better served if public health managers worked in collaboration with social service  professionals to provide a smooth transition to temporary benefits uptake for women who require (and are eligible for) assistance.

Program managers should implement educational programs and initiatives that increase knowledge (about breast cancer and mammography screening) and decrease fear (associated with having the test as well as  fear of dying from cancer).  Therefore, managers should take the following multi-level approach:

  • Develop and implement health communication campaigns, which include multi media messages that:
    –  Increase knowledge about breast cancer and mammography
    –  Increase awareness of the importance of mammography screening  
        for early detection of breast cancer
    –  Provide details about the screening process and how to reduce
    –  Develope community-based educational programs to dispell myths 
       about cancer treatment
  • Collaborate with religious leaders to develop health messages (with religious themes that support positive health behaviors such as health screenings) 
  • Collaborate with social service managers to develop a client referral system for those in need of social programs and patient advocacy
  • Develop cultural competency training targeting public health professionals (doctors, mammography technologists, nurses and medical receptionists) to improve quality of service delivery.
  • Develop program to improve administrative staff’s telephone skills to :
    –  Conduct appoinment reminder calls to clients 
    –  Conduct client satisfaction follow-up calls

Continued research is needed to better understand how a range of determinants influence mammography screening among African American women.  Study results can inform public health professionals regarding best practices to reduce rates of death from breast cancer among women in this population.

National Cancer Institute, Cancer Trends Progress Report, 2007 Update.



1. medhead - February 24, 2009

Watson – This being Black History Month, I’m surprised you didn’t mention, in your “cultural attitudes” section, fallout from the Tuskeegee experiments. Surely you’ll admit that any mistrust this population may have of the medical community is historically justified.


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