Running head: HEALTH BELIEFS AND SCREENING IN AFRICAN AMERICAN WOMEN
Health Beliefs and Breast Cancer Screening in African American Women Linda M. Frazier, RN, MSN, FNP-C
Medical College of Georgia
School of Graduate Studies
Health Beliefs and Breast Cancer Screening in African American Women
Breast cancer is the most common cancer and the second leading cause of death among women in the United States. More than 211, 000 U.S. women were diagnosed with breast cancer in 2005, and at least 40, 400 women died as a result of the disease (MacDonald, Sarna, Uman, Grant, & Weitzel, 2006). Breast cancer crosses all demographic lines, affecting women of all ages, races, ethnic groups, socioeconomic strata and geographic locales. Breast cancer is the most common cancer among African American women and one of the leading causes of cancer death in this population (Morgan, Fogel, Rose, Barnett, et al., 2005). African American women have a slightly lower incidence of breast cancer than Caucasian women, but suffer a 32% higher mortality rate as a result of the disease. One of the goals of Healthy People 2010 is to reduce the mortality rate from breast cancer and to do so a high percentage of females aged 40 years and older need to comply with screening recommendations (Stelger, Samkoff & Karoullas, 2003). Background
Breast cancer mortality rates in the United States began to decrease in the 1990s because of increased use of screening mammography and improved breast cancer treatment. These decreases have primarily been seen in non-Hispanic white women. Despite the abundance of health information regarding breast cancer screening and early detection, breast cancer mortality rates in African American women has changed little (Smith-Bindman, et.al., 2006). The five-year survival rate is 69 percent for African American women and 84 percent for Caucasian women (Belin, Washington, & Greebe, 2006; Tammemagi, Nerenz, Neslund-Dudas, Feldkamp, & Nathanson, 2005). Several causes have been identified, to include: differences in tumors, patient characteristics, such as obesity, that may affect prognosis; mammography use; timeliness and completeness of breast cancer diagnosis and treatment; social factors, such as education, literacy, and cultural beliefs; and economic factors, such as income level and health insurance coverage, that might affect a patient’s access to choices for breast cancer screening and treatment (Smith-Bindman et al., 2006). The focus of this paper is to explore reasons related to health and cultural beliefs, and other psychological factors that may impact screening and treatment behaviors among African American women regarding breast cancer.
The impact of psychosocial factors, including cultural health beliefs have been studied and suggest health beliefs and other psychosocial factors have a direct correlation with breast cancer morbidity, mortality and survival rates. Dispelling negative health beliefs in culturally sensitive programs may impact mortality and morbidity rates in African American women and other ethnic minorities (Altpeter, Mitchell, & Pennell, 2005; Mitchell, Lannin, Mathews, & Swanson, 2002). Discussion of the Evidence
Many researchers have suggested that at least half of the difference in survival between African American women and Caucasian women is due to late diagnosis and inadequate secondary prevention (Bibb, 2001; Smith-Bindman et al., 2006). Breast-self examination and clinical breast examinations are simple and effective methods of secondary prevention of breast cancer. Mammography combined with clinical breast examinations remains the most important means of decreasing breast cancer mortality (Russell, Champion & Skinner, 2006; Earp et al., 2002; Russell, Swenson, Skelton, 2003). Although increases in mammography screening among African American have occurred, screening behaviors still vary greatly among black women and trends show that the proportions of women ever...
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