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Reducing Breast Cancer Mortality in Black Women



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Am Fam Physician. 2003 Mar 1;67(5):1104-1106.

The incidence of breast cancer is slightly lower in black women than in white women in the United States. However, the mortality rate is higher in blacks, and this gap is increasing. While mortality rates for breast cancer in white women have decreased by about 2 percent per year for the past decade, rates in black women have been stable for much of this time. Although most of the difference in mortality rates is attributed to presentation at a relatively advanced stage, survival at each stage also is lower among black women. Lannin and colleagues examined explanations for disparities in the rates of breast cancer survival with a view to developing intervention strategies.

The authors first examined differences in uptake of mammography screening services. Because of several concerted community interventions, the disparity between white and black women's use of mammography has diminished, and more than 60 percent of all women 40 years or older have had mammography within the past year (see the accompanying figure). Programs that have been the most successful in increasing mammography screening uptake among low-income black women have used lay health advisors chosen from women in their community to whom others turn for advice and support. Black women also tend to accord great importance to physician recommendations. Ensuring that physicians arrange screening mammography for all appropriate black women appears pivotal to reducing breast cancer mortality in this group.

Mammography Use

FIGURE. Percentage of women older than 40 years who have had mammography in the past year (white bars = white persons; black bars = black persons).

Adapted with permission from Breen N, Wagener D, Brown ML, Davis WW, Ballard-Barbash R. Progress in cancer screening over a decade. Results of cancer screening from the 1987, 1992, and 1998 NHIS. National Health Interview surveys. J Natl Cancer Inst 2001;93:1706.

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Mammography Use


FIGURE. Percentage of women older than 40 years who have had mammography in the past year (white bars = white persons; black bars = black persons).

Adapted with permission from Breen N, Wagener D, Brown ML, Davis WW, Ballard-Barbash R. Progress in cancer screening over a decade. Results of cancer screening from the 1987, 1992, and 1998 NHIS. National Health Interview surveys. J Natl Cancer Inst 2001;93:1706.

Mammography Use


FIGURE. Percentage of women older than 40 years who have had mammography in the past year (white bars = white persons; black bars = black persons).

Adapted with permission from Breen N, Wagener D, Brown ML, Davis WW, Ballard-Barbash R. Progress in cancer screening over a decade. Results of cancer screening from the 1987, 1992, and 1998 NHIS. National Health Interview surveys. J Natl Cancer Inst 2001;93:1706.

Even when economic and health care access issues are accounted for, racial differences remain in the stage at diagnosis and outcomes of treatment for breast cancer. The authors surveyed 1,500 women (54 percent white and 46 percent black) about their attitudes and beliefs concerning breast cancer (see the accompanying table). Among the results of this survey, blacks were more likely than whites to report a reliance on God to cure cancer without medical intervention, fatalism that medical and especially surgical treatment would be futile, a specific belief that surgery makes cancer spread more quickly, belief that a painless lump cannot be cancer, and reliance on alternative therapies. Blacks also were much less confident about support from male partners, and 30 percent reported that a man would probably leave a woman who had a breast removed.

Cultural Beliefs About Breast Cancer*

Beliefs Whites (%) Blacks(%)

How worried are you about breast cancer? Answer: not worried at all.

43

65

As long as the lump doesn't hurt, it is not cancer. Answer: false.

97

86

A breast cancer can be cured if it is found early.

96

81

If a breast cancer is operated on, it can be stopped from getting bigger.

77

55

Women who get breast cancer lose their breasts.

10

32

If a lump turned out to be cancer and your doctor recommended it, would you:

Have surgery?

93

79

Have chemotherapy?

80

66

Have radiation?

77

56

Doctors and other health care professionals are the ones I would trust most to decide how to treat cancer.

80

58

A man would probably leave a woman if she had to have her breast removed.

9

30

Women who have surgery for breast cancer are no longer attractive to men.

6

14

A man would probably not stay with a woman if she had breast cancer.

6

27

If air gets to cancer during surgery, the cancer will grow faster.

31

48

Herbal remedies are more effective than medicines against cancer.

7

12

If you were told you had breast cancer, would you believe that:

God would work through doctors and nurses to cure your cancer?

91

96

God is more likely to cure your cancer than medical treatments?

41

60

Only a religious miracle could cure your cancer, not medical treatment?

7

24

The strength of your own faith in God would determine if your cancer was cured?

22

65


*—Survey of nearly 1,500 women in North Carolina in 2000.

†—All differences significant at P <0.001.

Adapted with permission from Lannin DR, Mathews HF, Mitchell J, Swanson MS. Impacting cultural attitudes in African-American women to decrease breast cancer mortality. Am J Surg 2002;184:421.

Cultural Beliefs About Breast Cancer*

View Table

Cultural Beliefs About Breast Cancer*

Beliefs Whites (%) Blacks(%)

How worried are you about breast cancer? Answer: not worried at all.

43

65

As long as the lump doesn't hurt, it is not cancer. Answer: false.

97

86

A breast cancer can be cured if it is found early.

96

81

If a breast cancer is operated on, it can be stopped from getting bigger.

77

55

Women who get breast cancer lose their breasts.

10

32

If a lump turned out to be cancer and your doctor recommended it, would you:

Have surgery?

93

79

Have chemotherapy?

80

66

Have radiation?

77

56

Doctors and other health care professionals are the ones I would trust most to decide how to treat cancer.

80

58

A man would probably leave a woman if she had to have her breast removed.

9

30

Women who have surgery for breast cancer are no longer attractive to men.

6

14

A man would probably not stay with a woman if she had breast cancer.

6

27

If air gets to cancer during surgery, the cancer will grow faster.

31

48

Herbal remedies are more effective than medicines against cancer.

7

12

If you were told you had breast cancer, would you believe that:

God would work through doctors and nurses to cure your cancer?

91

96

God is more likely to cure your cancer than medical treatments?

41

60

Only a religious miracle could cure your cancer, not medical treatment?

7

24

The strength of your own faith in God would determine if your cancer was cured?

22

65


*—Survey of nearly 1,500 women in North Carolina in 2000.

†—All differences significant at P <0.001.

Adapted with permission from Lannin DR, Mathews HF, Mitchell J, Swanson MS. Impacting cultural attitudes in African-American women to decrease breast cancer mortality. Am J Surg 2002;184:421.

The authors conclude that black and white women see the world differently and interpret cancer and its treatment in the context of cultural beliefs. While these beliefs might cause women to avoid screening, this could be overcome by appropriate counseling from community members and especially from physicians. Actions on discovering a lump and decisions about participating in therapy are much more complex. The authors urge physicians to learn more about the beliefs of black women and to address these beliefs specifically in developing treatment strategies that can be effective.

Lannin DR, et al. Impacting cultural attitudes in African-American women to decrease breast cancer mortality. Am J Surg. November 2002;184:418–23.



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