"Sympathy for my body": breast cancer and mammography at two Atlanta clinics

Feeling Indecent: Breast Cancer Screening Resistance of Mexican-descent Women

This grounded theory study investigated how Mexican-descent women's traditional cultural beliefs, values, and norms regarding the propriety of their behavior and that of their health care providers influence their decision to participate in breast cancer screening. Thirty-four women (aged 49–81 years old) were interviewed in five focus groups using theoretical sampling across levels of acculturation and socioeconomic status. We discovered that the women's basic social-psychological problem is that screening is an insensitive procedure that violates their cultural standards by requiring inappropriate behavior. The risk involved is ‘feeling indecent’ since both touching one's breast and breast exposure to health care providers is prohibited according to cultural norms for respectable female behavior. Thus, women resist participating in breast cancer screening to avoid feeling indecent.

Cultural sensitivity and health promotion: assessing breast cancer education pamphlets designed for African American women

This study discusses the implications for cultural sensitivity of the rhetorical choices in breast cancer education materials developed specifically for African American audiences by national organizations. Using the PEN-3 model of cultural sensitivity as an analytic framework for a generative rhetorical criticism, this study revealed that adaptations have been made in some pamphlets to acknowledge African American cultural values related to community, self-reliance, spirituality, and distrust of the Western medical establishment, but many messages could be revised to achieve a more comprehensive, balanced, accurate, and audience-specific discussion of the breast cancer issue. Achieving cultural sensitivity in health promotion materials necessitates attention to nuanced meanings in messages, revision of questionable arguments and evidence, and avoidance of ambiguity.

Influence of traditional Chinese beliefs on cancer screening behaviour among Chinese-Australian women

AIM

This paper reports a study exploring how traditional Chinese life philosophy, including fatalism, influences understanding of the concepts of health and illness, and the impact of these concepts on cancer screening behaviour.

BACKGROUND

The language of risk is central to contemporary Western understanding of health and illness. Women aged over 50 years are considered at risk of developing breast cancer and are highly recommended to undergo regular mammographic screening. However, screening rates among Chinese women are consistently lower than for most other groups.

METHODS

In-depth interviews, in Cantonese, were conducted with a convenience sample of 20 Chinese-Australian women, and the data analysed thematically, using case summaries, coding and matrix tables. The data were collected in 2001.

FINDINGS

The findings revealed that when dealing with cancer prevention, Chinese-Australian women are heavily influenced by cultural traditions related to the life-cycle and disease prevention. Informants believed that contracting disease, including cancer, is inevitable and that there is no way to prevent it. Fatalism appears to be a significant barrier to their participation in cancer screening services.

CONCLUSION

Our findings suggest that the effects of breast cancer screening and other health promotion programmes, which are general and do not take account of cultural variations may be compromised when it comes to cultural minorities. In the case of older Chinese-Australian women, breast cancer screening promotion programmes may overcome acceptance of fatalistic philosophy if they emphasize increased risk following immigration.

Factors associated with mammographic decisions of Chinese-Australian women

BreastScreen (a free breast cancer screening service) has been implemented in Australia since 1991. Surveys conducted overseas consistently report that women of Chinese ancestry have low participation rates in breast cancer screening. Although Chinese women's use of breast cancer screening services has been investigated abroad, to date there are few studies of mammographic screening behavior among Chinese-Australian women. The purpose of this study is to explore and investigate the factors associated with mammographic decisions of Chinese-Australian women. Using a qualitative approach, in-depth interviews were conducted with 20 Chinese-Australian women. These were augmented by additional data from ethnographic observations. The findings show two facilitators: organizational factors (an invitation letter from BreastScreen and seniors' clubs arrangements) and the influence of 'significant others'. Barriers identified were fear perceptions of mammography, modesty and fear of stigmatization. This study provides a useful framework for designing and implementing mammographic screening services for Chinese-Australian women that may improve their participation rates.

Brief report: etiological attributions for breast cancer among healthy African American and European American women

Anecdotal evidence suggests that African American women's attributions about breast cancer may differ from European American women, but empirical studies are lacking. The present study examined attributions about breast cancer made by a sample of healthy African American and European American women. The sample included 197 women (75 African American, 122 European American), with a mean age of 39.2. Overall, women were most likely to attribute the development of breast cancer to genetics, "no one", environmental poisons, diet, personal behavior and stress. European American women were more likely to attribute breast cancer to broadly external causes such as the environment, heredity and chance, while African American women were more likely to list immediate, interpersonal-level causes such as a blow to the breast, and personal behavior. Results highlight the need for attention to cultural processes in cancer prevention and control.

Feeling healthy: so why should Mexican-descent women screen for breast cancer?

Mexican-descent women are at particular risk of late-stage breast cancer diagnosis by being the least likely of the major U.S. Hispanic subgroups to undergo breast cancer screening. This grounded theory study investigated how cultural health beliefs regarding the causes and nature of breast cancer influence women's decision to participate in screening. Thirty-four women (age 49 to 81) were interviewed in five focus groups using theoretical sampling across levels of acculturation and socioeconomic status. Analysis of the most prevalent cultural health beliefs led to a discovery that the core problem Mexican-descent women face is that they perceive there is no reason to participate in breast cancer screening when they are "feeling healthy." In addition, women who subjectively and cognitively feel healthy and otherwise have no evidence of illness according to their cultural health beliefs are unlikely to risk feeling ill rather than healthy by seeking to discover breast cancer through screening.

Factors that influence cancer screening in older African American men and women: focus group findings

Cancer incidence and mortality rates are highest among African Americans. A series of focus groups were conducted with older African American men and women to identify and examine psychosocial factors that influence screening behavior. Facilitators and barriers to screening as well as other factors that impact screening behaviors were explored. Study results indicate that African American men and women perceive screening in different ways. While there were similarities in the perceptions and facilitators to cancer screening, distinct gender differences were identified in the barriers and specific factors that influence cancer screening.

Cancer experiences of African-American women as portrayed in popular mass magazines

Popular magazines provide opportunities for teachable moments about cancer prevention and control to broad segments of the population. The purpose of this study was to evaluate attitudes and beliefs about cancer as presented in magazine cancer stories with a predominant readership of African-American women. Information was collected on full length cancer stories in Jet, Ebony and Essence from 1987 to 1995. There were 11 personal stories about cancer impact on women in the magazine issues over 9 years. Five themes emerged: religiosity, cancer fatalism, quality of life after diagnosis, interactions with medical personnel, and treatment choices. Within each theme area, specific subthemes were identified. Within religiosity, subthemes included the importance of faith, God's role, and the challenge to the spirit of a cancer diagnosis. Negative interactions with the medical system were described in 45% (5/11) of the stories. Quality of life emerged as an important issue in the cancer stories with death and dying, and pain or side-effects of treatment appearing in 64% (7/11) of the narratives. These results suggest that narratives in magazines with predominant readership among African-American women emphasize religious beliefs in cancer survival and present mixed attitudes towards European-American medical institutions. Mass media contributes to that discourse which shapes women's attitudes about survival from cancer.

Nonadherence to follow-up treatment of an abnormal Pap smear: a case study

This article is a case study of a 32-year-old African-American woman diagnosed with an abnormal Pap smear, who did not follow through with the recommended colposcopy procedure. This case study highlights the role of illness explanatory models in nonadherence to follow-up treatment for an abnormal Pap smear. Illness explanatory models are an individual's personal interpretation of the illness. Research indicates that patients' illness explanatory models may not agree with biomedical explanations, but may sometimes have an adverse impact on health and illness behavior. This case study draws attention to the impact of illness explanatory models of cancer resulting from experience with cancer in the family, personal belief systems, and spiritual faith on the patient's decision not to follow through with recommended treatment for an abnormal Pap smear. Addressing illness explanatory models is of clinical importance in determining methods that will motivate women to follow through with treatment protocols when diagnosed with an abnormal Pap smear. Further in-depth study of the role these explanatory models of cancer play in nonadherence to treatment protocols is needed.

Minority women and breast cancer screening: the role of cultural explanatory models

Mammography and clinical breast exams are effective secondary prevention techniques for reducing the morbidity and mortality due to breast cancer. Although minority women have higher mortality rates due to breast cancer, they are less likely than white women to use screening procedures. This paper provides a complementary understanding of the use of breast cancer screening among minority women by drawing attention to the role of women's cultural explanatory models (CEMs). CEMs stem from the sociocultural context and involve cultural beliefs and values, personal life experiences, and both biomedical and popular explanations of health and illness. Although women's CEMs may not accord with those of health professionals, they do have an impact on screening behavior. This paper discusses suggestions for addressing these issues in an effort to improve breast cancer screening rates through adopting a cultural relativistic approach.

Psychological predictors of attendance at annual breast screening examinations

This retrospective analysis of psychological predictors of attendance studied the women from the annual screening arm of the United Kingdom Coordinating Committee on Cancer Research (UKCCCR) trial of annual screening mammography for the early detection of breast cancer. Some women attended screening at the first invitation in year 1 (attenders), others did not attend for screening at any time (non-attenders), whereas a third group delayed attending until year 2 (ambivalent attenders). A total of 147 women were recruited to the study: 80 attenders, 28 non-attenders and 39 ambivalent attenders. It proved extremely difficult to contact non-attenders to take part in the study. Non-attenders were significantly more depressed on the Hospital Anxiety and Depression Scale; had experienced more miscarriages, stillbirths or terminations of pregnancy; were less knowledgeable about mammography; and were displeased to have received an invitation to screening. Whereas non-attenders are unlikely ever to attend breast screening because of their long-standing attitudes and preferred coping styles, ambivalent attenders may become more amenable to screening with the passage of time. In this study such women were persuaded to attend in year 2 with a simple, cost-effective intervention: an additional invitation letter after a year.