Cancer Screening Experiences of Black Breast and Ovarian Cancer Patients and Family Members

Black women experience disproportionate rates of advanced breast cancer diagnoses and mortality. Mammography is a proven and effective tool in early breast cancer detection and impacts patient outcomes. We interviewed Black women with a personal or family history of breast and/or ovarian cancer to understand their screening experiences and views. N = 61 individuals completed an interview. Interview transcripts were qualitatively analyzed for themes regarding clinical experiences, guideline adherence, and family sharing specific to Black women and their families. Most participants were college educated with active health insurance. Women in this cohort were knowledgeable about the benefits of mammography and described few barriers to adhering to annual mammogram guidelines. Some with first-degree family history were frustrated at insurance barriers to mammography before the age of 40. Participants were generally comfortable encouraging family and friends to receive mammograms and expressed a desire for a similar screening tool for ovarian cancer. However, they expressed concern that factors such as screening awareness and education, lack of insurance coverage, and other systematic barriers might prevent other Black women from receiving regular screening. Black women in this cohort reported high adherence to mammography guidelines, but expressed concern about cultural and financial barriers that may impact cancer screening access in the population more generally and contribute to disparities. Participants noted the importance of frank and open discussions of breast cancer screening in their families and community as a means of improving awareness.

Understanding Breast Cancer Disparities Affecting Black Women: Obtaining Diverse Perspectives Through Focus Groups Comprised of Patients, Providers, and Others

Black women have the highest death rate from breast cancer and a higher chance of developing breast cancer before the age of 40 than White women. Mammography screening is recommended for early detection which has led to decreased mortality and improved survival. Unfortunately, Black women are less likely to have breast cancer screenings. Environmental justice communities represent place-based structural disparity/racism leading to health inequality. Environmental justice specifically addresses situations where minority or low-income communities bear disproportionately poor human health outcomes and environmental risks. The purpose of this qualitative study was to gain a deep understanding of breast cancer screening disparity from multiple perspectives to enable collective solutions to barriers faced by Black women in an environmental justice community. Data were collected from 22 participants using a focus group approach from Black women with breast cancer (n = 5) and without it (n = 5), healthcare providers (n = 6), and community leaders (n = 6). An iterative and inductive thematic data analysis method was used to analyze data. The themes that emerged from the data included: (1) misconceptions and fear of mammograms; (2) breast cancer screening beyond mammograms; and (3) barriers beyond mammograms. These themes reflected personal, community, and policy barriers leading to breast cancer screening disparity. This study was an initial step to develop multi-level interventions targeting the personal, community, and policy barriers that are needed to advance breast cancer screening equity for Black women living in environmental justice communities.

Determine knowledge and belief of Somalian young women about breast cancer and breast self-examination with champion health belief model: a cross-sectional study

BACKGROUND

Breast cancer (BC) is an important reason for mortality rates in Somalian women. In Somalia, many women are late in applying to the hospital for the diagnosis of BC. Breast self-examination (BSE) is considered an important early detection method for BC in encouraging women to learn to practice BSE, especially for women in developing countries. This study purposed to determine knowledge, and belief of BC and BSE and BSE practice among women in Mogadishu, Somalia using the champion health belief model (CHBM).

METHODS

This cross-sectional study was conducted on 413 women who were between 18 and 49 years of age. The data were collected by using sociodemographic variables (age, marital status, education level, income status), Champion's Health Belief Model Scale (CHBMS), and an introductory questionnaire with questions about BC and BSE and between October 2020 and January 2021 in Mogadishu, Somalia. Further descriptive statistics, the Mann-Whitney U test, and Kruskal-Wallis analysis test were used to assess data that were not normally distributed.

RESULTS

Average age of participants was 22 ± 11.21 years. Only 35.4% of participants had information about BC, 37.8% had heard about BSE before, 25.2% knew BSE, and only 17.2% had done it. Income status, marital status, and age of first birth family were significantly associated with perceived sensitivity, health motivation, convenience, perceived benefits, and self-efficacy for BSE. Overall, the total scores of CHBMS were significantly higher among those who had heard and knowledge about BSE and practiced clinical breast examination (CBE). For the sub-dimensions of perceived sensitivity, health motivation, perceived benefits, barrier, and self-efficacy BSE with hearing about BSE, practicing BSE, knowing to practice BSE, knowing early detection methods of BC and practice CBE significant differences were observed (P < 0.005).

CONCLUSION

This study showed that BSE practice among Somalian women was very low, and they don't have sufficient knowledge about BSE and BC. Furthermore, this study revealed that many CHBMS significantly related to BSE practice in Somalian women, suggesting that BSE health education programs with CHBMS.

Psychological factors among Appalachian women with abnormal Pap results

PURPOSE

Women who receive an abnormal Pap result may experience negative psychological factors. The purpose of this study is to assess the baseline occurrence of negative psychological factors and evaluate the relationships between psychological factors and demographic characteristics among Appalachian women who received abnormal Pap results.

METHODS

We conducted a secondary analysis of data collected from Appalachia Kentucky women (N = 521) ages ≥18 enrolled in an intervention. Data included sociodemographics, Beck depression and anxiety inventories, fatalism, and personal control measures. Multiple variable logistic regression was used to investigate the association between demographics and psychological factors.

FINDINGS

Participants were predominantly White (96.2%), with mean age 28.93 ± 11.03 years, and the majority (77%) had yearly income below $20,000. Depression was reported by 34.6% (n = 173); 10% (n = 50) experienced moderate or severe anxiety; 20.6% (n = 107) had fatalistic beliefs; and 55.1% (n = 289) believed they lacked personal control over cancer. Women with lower income had higher occurrence of depression (P = .003). Women with moderate to severe anxiety were significantly older than those with low to moderate depression (34.44 vs 28.34, P < .001). Controlling for other variables, as age increased, the odds of fatalistic beliefs increased, OR (95%) = 1.042 (1.022, 1.062). When education level increased, the odds of fatalistic beliefs decreased, OR (95%) = 0.873 (0.800, 0.952).

CONCLUSIONS

Given the high occurrence of depression, anxiety, and fatalistic beliefs among this population, health care providers should assess for underlying mental health diagnoses and psychological distress during each patient encounter and provide recommendations to address them.

Access to Care as a Barrier to Mammography for Black Women

Racial disparities in breast cancer screening, morbidity, and mortality persist for Black women. This study examines Black women's mammography beliefs and experiences with specific focus on barriers to mammography access in an urban city in the South East, United States. This retrospective, qualitative study used Penchansky and Thomas' conceptualization of health care access as the framework for the data analysis. In-depth, semistructured interviews were conducted with 39 Black women. Structural and personal factors continue to create barriers to mammography among Black women. Barriers to mammography were identified for each of the Penchansky and Thomas five dimensions of access to care: accessibility, affordability, availability, accommodation, and acceptability. Clinical practice strategies to increase mammography screening in Black women must be multifactorial, patient-centered, and culturally congruent. Policy development must address the structural barriers to mammography screening through expansion of health insurance coverage and increased accessibility to health care.