The severity of breast cancer at diagnosis: a comparison of age and extent of disease in black and white women

Breast self-examination: knowledge, attitudes, and performance among black women

This survey assessed the reported frequency of breast self-examination (BSE): the knowledge of the technique and attitudes regarding the self-exam of 180 black women. Most respondents indicated having practiced the exam during the previous year, and 50% reported practicing it monthly or more often. Less than half of the sample indicated performing the exam according to American Cancer Society guidelines, although 92% reported being either very confident or somewhat confident of their performance ability. Attitudinal and demographic variables were tested for significant relationships with BSE practice. Compared with nonperformers, BSE performers were older, had higher annual incomes, and were more likely to believe in the benefits of BSE, to perceive social approval for BSE practice, to have been taught to perform BSE, to have had a Pap smear, a clinical breast exam, and a general physical exam within one year, and to visit a physician in a private office or clinic (as opposed to a hospital emergency room). Frequency of self-examination was significantly associated with the performer's competency level, age, belief in the benefits of performing BSE, perceived social approval for practice, having been taught to perform the exam, and level of confidence in ability to perform it.

Cancer rate differentials between blacks and whites of three metropolitan areas

This article presents a comparison of the cancer incidence and mortality rates for the populations of the metropolitan areas of Los Angeles, Atlanta, and Nashville. The results reveal that cancer of the lung, prostate, breast, and cervix should be of major concern to all, but especially to blacks and residents of Nashville. The findings have specific implications for the prevention of cancer in the black population of the United States.

Lung, breast, and colorectal cancer: the relationship between extent of disease and age at diagnosis

We examined the relationship between age and extent of disease at initial diagnosis as part of a population-based, prospective study documenting the patterns of care received by over 1500 newly diagnosed lung, breast, and colorectal cancer patients identified in nine Rhode Island hospitals. For each cancer site examined, no age by extent of disease relationship was observed; however, analysis by sex among lung cancer patients indicated an inverse age relationship for men. The absence of an age effect for breast cancer patients is in contrast to earlier research findings that identify a positive association between extent of disease and age at diagnosis. Past results may reflect age-related differences in patient and physician screening behavior characteristic of earlier time periods.

The need and value of breast self-examination

The incidence of breast cancer is higher for black women aged less than 40 years than for white women aged less than 40; however, both black and white women aged less than 35 years have the lowest breast cancer survival rates of all age groups. The issue of breast self-examination (BSE) efficacy has special implications for these women because the BSE and the clinical breast examination (CBE) are the only early detection techniques recommended to them. Breast self-examination is even more important for black women because CBE might not be accessible to them for economic or other reasons.Studies relating BSE practice to tumor stage were reviewed. Most of the evidence was favorable, although it was not obtained with the most scientific methodologic approach. The negative evidence, on the other hand, came from studies with additional methodologic and conceptual problems, and should have little impact when evaluating BSE efficacy.Competence of performance has been shown to affect the efficacy of the self-examination. Most studies on BSE value, however, did not assess the examiner's competence. Because data obtained elsewhere show that most women performing BSE do not perform it competently, the significance of the positive evidence on BSE value is heightened. Most breast tumors are self-discovered, and encouraging competent BSE performance will give more women better means to discover tumors earlier.

Differences in physician prevention practice patterns for white and minority patients

A telephone survey of 120 randomly selected primary care physicians in New York City was completed in October, 1984 (response rate = 90%) concerning physicians' recommendations for health promotion and disease prevention. Responses from physicians with 50% or more Black and Hispanic patients were compared with responses from physicians with 50% or more White patients. The former were found to be less likely to follow guidelines from nationally recognized organizations for health promotion and disease prevention, although they were just as likely to value the importance of prevention in primary care. For example, physicians with predominantly Black and Hispanic patient populations were significantly less likely to recommend screening mammography (7% versus 23%) or recommend influenza vaccination for patients 65 or older (48% versus 74%) when compared with physicians with predominantly White patient populations. Factors that appeared to contribute to the difference in prevention practice patterns include physician training and education, the socioeconomic status of the patients, and the time physicians spend with patients. Differences in quality of preventive care provided to minority patients may be an additional factor in the disparity between the health status of White and non-White Americans.