African American women's breast memories, cancer beliefs, and screening behaviors

African American women experience higher breast cancer mortality and lower survival rates compared with white women of comparable age and cancer stage. The literature is lacking in studies that address the influence of past events on current health behaviors among women of diverse cultural groups. This qualitative exploratory study used participant narratives to examine associations between women's memories and feelings concerning their breasts and current breast cancer screening behaviors. Twelve professional African American women, aged 42 to 64 years, shared stories about memories and feelings regarding their breasts. Codes grouped together with related patterns and recurrences revealed categories that encompassed the language and culture of the participants. The categories identified were Seasons of Breast Awareness, Womanhood, Self-Portraits, Breast Cancer and Cancer Beliefs, Breast Cancer Screening Experiences, and Participants' Advice for Change. These categories provide direction for further exploration of barriers to health promotion practices among African American women and women in general.     

African American Women's Experiences with Breast Cancer Screening

Purpose: To describe the experience and meaning of breast cancer screening for African American women. Breast cancer screening offers the greatest hope of reducing breast cancer mortality and improving breast cancer outcomes. Despite the proliferation of initiatives targeting African American women, they continue to be first diagnosed only when they have late-stage disease.
Design and Methods: Using hermeneutic phenomenological research methods, 23 low-and middle-income African American women were interviewed to gain an understanding of their experiences with breast cancer screening.
Findings: Participants varied in their experiences with breast cancer screening. Women spoke of a desire for a holistic approach to health that did not separate the breast from the rest of the body. This desire is indicated in the theme of minding the body, self, and spirit, along with themes of relationships and spreading the word about breast health issues.
Conclusions: Interventions for African American women should include a focus on minding the body, self, and spirit to promote breast cancer screening, and should indicate the importance of relationships and spreading the word about breast cancer screening.     

Attitudes toward participation in breast cancer randomized clinical trials in the African American community: a focus group study

Participation of African Americans in research trials is low. Understanding the perspectives of African American patients toward participation in clinical trials is essential to understanding the disparities in participation rates compared with whites. A qualitative study was conducted to discover attitudes of the African American community regarding willingness to participate in breast cancer screening and randomized clinical trials. Six focus groups consisting of 8 to 11 African American women (N = 58), aged 30 to 65, were recruited from local churches. Focus group sessions involved a 2-hour audio-taped discussion facilitated by 2 moderators. A breast cancer randomized clinical trial involving an experimental breast cancer treatment was discussed to identify the issues related to willingness to participate in such research studies. Six themes surrounding willingness to participate in randomized clinical trials were identified: (1) Significance of the research topic to the individual and/or community; (2) level of trust in the system; (3) understanding of the elements of the trial; (4) preference for "natural treatments" or "religious intervention" over medical care; (5) cost-benefit analysis of incentives and barriers; and (6) openness to risk versus a preference for proven treatments. The majority (80%) expressed willingness or open-mindedness to the idea of participating in the hypothetical trial. Lessons learned from this study support the selection of a culturally diverse research staff and can guide the development of research protocols, recruitment efforts, and clinical procedures that are culturally sensitive and relevant.     

Health Beliefs of African American Women on Breast Self-Exam

PurposeInvestigate the relationship between African American women's health beliefs in regard to breast cancer screening behaviors.Data sourcesA sample of 131 African American women, age 20–65, from a family practice clinic and 3 rural churches in Southeast.ConclusionsOne-hundred and nine of the participants reported practicing breast self-exam (BSE) within the past 12 months. However, 21 women had never practiced BSE. Fear of not doing it correctly was a main barrier.Implication for practiceSteps should be taken to increase confidence and resolve barriers of African American women through the development of culturally sensitive educational training on BSE and cancer prevention.     

Promoting breast health: older women's perceptions of an innovative intervention to enhance screening

Aims and objectives. This study is a continuation of prior funded research in which we tested the use of age and ethnically sensitive video breast health kits to increase knowledge about breast cancer and enhance the screening practices of breast self‐examination and mammography among older Caucasian and African‐American women. Background. Breast cancer is the most frequent cancer in women worldwide and accounts for 23% of all cancers. Mammography is currently the best procedure available for mass screening of breast cancer. However, underutilization of mammography is a problem among older women in the United States. Elders are at the greatest risk for developing and dying from breast cancer but they are the least likely group to be screened routinely with mammograms or to practice breast self‐examination, particularly if they are African‐American. Design. Participatory qualitative evaluation focus groups were used to assess the overall impact of the video kit intervention programme and to elucidate the quantitative findings of the original study. Methods. Four focus groups were conducted in two diverse settings with a purposive sample of 23 participants (N = 23). The overall sample was predominantly African‐American (87%) with mean age of 71 ± 7.9 years and mean education completed of 12 ± 3.4 years. Results. Five major themes emerged from group discussions: usability and appeal of the intervention, fear and empowerment, personal relevance and intergenerational sharing, impact on screening behaviours, and story telling. Conclusions. Analyses suggest that customized media materials constructed especially for older African‐American women empowered participants in this sample to action regarding their own breast health. Relevance to clinical practice. These findings may translate to global populations where risk is increasing but screening programmes are not widely available. Given that older women are historically difficult to access and impact, further design and evaluation of innovative and sensitive educational programmes such as the one described here are recommended.     

Cancer fatalism and breast cancer screening in African American women.

Despite significant advances in science, medicine, and technology African American women are more likely to die from breast cancer than Caucasian women. There is a growing body of literature that describes strategies to improve breast cancer screening among African American women. However, data suggest that African American women, compared to Caucasian women, are less likely to participate in regular breast cancer screening. The belief that a diagnosis of cancer will result in death has been identified as a potential barrier to cancer screening in African American population groups. However, research examining the degree to which perceptions of fatalism influence breast cancer screening in culturally and ethnically diverse population groups is scant. This repot describes the outcomes of a study undertaken to examine relationships between perceptions of cancer fatalism and breast cancer screening in African American women. Findings support the postulation that fatalism negatively influences health promoting practices such as breast cancer screening. However, contrary to prior research findings age was observed to be inversely associated with cancer fatalism.     

Lay health advisors: promoting cancer screening and reducing disparities

Cancer health disparities between racial and ethnic minorities have led to the use of lay health advisors to educate minority populations about cancer and promote cancer screening and other healthy behaviors. This article discusses the benefits of using lay health advisors to increase cancer awareness and screening in African American, Vietnamese, and Hispanic women in the United States.     

Cancer risk-reduction behaviors of breast cancer survivors

Using secondary data analysis, the aim was to determine if postmenopausal women, who have survived breast cancer, have adopted healthy nutritional and physical activity behaviors recommended in the American Cancer Society guidelines as cancer risk-reduction strategies, and in guidelines for prevention of other chronic diseases or for improving general health. From their personal health history, women who have survived breast cancer would be likely candidates to adopt healthy behaviors recommended as cancer risk-reduction strategies or for prevention of other chronic diseases. A secondary aim was to determine the perceived general health and affective state of these women. These breast cancer survivors had a high perception of their general health, a positive affective state, and have adopted some healthy lifestyle behaviors, but they are not fully adhering to the ACS nutrition and physical activity guidelines or other health related guidelines for cancer risk reduction or prevention of other chronic diseases.     

African American women and breast cancer: notes from a study of narrative

Survival after breast cancer and after all cancers is significantly worse for African American women than for others. Although many reasons have been proposed, no studies have explored the reception of messages about breast cancer by African American survivors of this disease, and how public images and discourses about breast cancer affects both their perceived risk for this disease and their experiences of illness. Narrative accounts of their lived experiences with breast cancer were collected from 23 African American survivors of breast cancer. Three themes have emerged: (a) Breast cancer is perceived to be a white woman's disease; (b) cancer is caused by experiences of repeated traumatic heartbreak; and finally, (c) there is a perceived lack of social support and understanding for the unique life experiences of the African American survivor of breast cancer. Nurses are on the front line of patient care. In the context of the managed care environment, they spend more time with patients than other health care providers and are soundboards for many patient concerns. As such, they can use the information provided in this study to inform high-risk women, current patients, partners, and other individuals in the medical community of how African American women might inaccurately access their personal risks for breast cancer, despite the public emphasis on this disease. Through the use of culturally sensitive pamphlets, nurses and other medical practitioners can also open discussions with underserved and minority patients as a means of realistically addressing some of these women's fears about breast cancer. These fears are barriers to effective cancer prevention because these individuals may consciously or unconsciously link a diagnosis of breast cancer, or even behaviors related to cancer prevention, to a potential death sentence.     

Adapting Champion's Breast Cancer Fear Scale to colorectal cancer: Psychometric testing in a sample of older Chinese adults

PurposeColorectal cancer (CRC) is the most common type of cancer in both men and women, and older adults are more susceptible to this disease. Previous studies suggest that cancer fear may be a key predictor of participation in cancer screening. Yet there is a lack of validated measuring tools of fear relating to CRC for the Chinese older adult population. This study aims to test the psychometric properties of the Chinese version of the Colorectal Cancer Fear Scale (CRCFS), adapting from the Champion's Breast Cancer Fear Scale.MethodsThe CRCFS was developed by altering the wording ‘breast cancer’ to ‘colorectal cancer’. Interviewer-administered surveys were carried out with a convenience sample of 250 community-dwelling adults aged at least 60 years old without a history of cancer. A subsample of 40 participants completed the scale again at one-month.ResultsConfirmatory factor analysis revealed that the one-factor model provided excellent fits to the overall data, and two randomly split samples. Cronbach's alpha of the scale was 0.95 and test-retest reliability was 0.52. Positive and significant correlations of CRC Cancer Fear with CRC-related susceptibility, severity and barriers were observed. A non-linear relationship with benefits was found.ConclusionsThe findings provide support for the psychometric properties of a Chinese version of the Champion Cancer Fear with an adaption to CRC in a sample of community dwelling older Chinese adults. The scale provides a useful tool to assess CRC-related fear, which interventions should address in order to improve screening rates among older Chinese adults.     

Getting Black Women to Screen for Cancer: Incorporating Health Beliefs Into Practice

Designing a culturally appropriate, user-friendly cancer screening and educational program is a challenge for nurse practitioners, particularly when working with populations having poor health promotion behaviors. Health beliefs have been identified as being influential in health promotion behaviors, particularly among African American women, making the understanding of specific health beliefs regarding cancer important for the nurse practitioner providing care. This paper presents a strategic plan to increase health promotion behaviors regarding cancer prevention and early detection among African American women by incorporating their health beliefs into clinical practice.     

A four-phase program to recruit African American women into breast cancer promotion programs.

The author discusses a successful, nurse-coordinated collaborative community-based breast health program that targeted older African American women from the state of South Carolina. Over 16 community organizations and health care partners supported the four-phase program that was funded by the South Carolina Breast and Cervical Risk Reduction Program and the South Carolina Chapter of the American Cancer Society.     

Physical and Psychological Abuse among Seropositive African American MSM 50 Aged Years and Older

Little is known about abuse experienced among African American men who have sex with men (MSM) who are 50 years and older. A series of focus groups were conducted to examine perspectives of seropositive African American MSM age 50 years and older who reported experiencing some form of psychological or physical abuse. Thirty African American MSM were divided into four focus groups and four themes emerged: “Fear Being Gay,” “No One Else to Love Me,” “Nowhere to Turn,” and “Sexual Risk & Control.” The data suggest there is a need to develop culturally tailored interventions for this population.     

Screening for breast cancer: current recommendations and future directions

Breast cancer is one of the most significant health concerns in the United States. Recent reviews have questioned the value of traditional breast cancer screening methods. Breast self-examination has been shown not to improve cancer-specific or all-cause mortality in large studies, but it is commonly advocated as a noninvasive screen. Patients who choose to perform self-examination should be trained in appropriate technique and follow-up. The contribution of the clinical breast examination to early detection is difficult to determine, but studies show that sensitivity is highly dependent on time taken to do the examination. Up to 10 percent of cancers are mammographically silent but evident on clinical breast examination. The U.S. Preventive Services Task Force recommends mammography for women older than 40 years who are in good health, but physicians should consider that sensitivity is lower for younger women. Digital mammography is somewhat more sensitive in younger women and women with dense breasts, but outcome studies are lacking. Although magnetic resonance imaging shows promise as a screening tool in some high-risk women, it is not currently recommended for general screening because of high false-positive rates and cost. The American Cancer Society recommends annual magnetic resonance imaging as an adjunct to screening mammography in high-risk women 30 years and older.     

Preventing Breast Cancer Through Identification and Pharmacologic Management of High-Risk Patients

Breast cancer remains the most common cancer in women in the United States. For certain women at high risk for breast cancer, endocrine therapy (ET) can greatly decrease the risk. Tools such as the Breast Cancer Risk Assessment Tool (or Gail Model) and the International Breast Cancer Intervention Study risk calculator are available to help identify women at increased risk for breast cancer. Physician awareness of family history, reproductive and lifestyle factors, dense breast tissue, and history of benign proliferative breast disease are important when identifying high-risk women. The updated US Preventive Services Task Force and American Society of Clinical Oncology guidelines encourage primary care providers to identify at-risk women and offer risk-reducing medications. Among the various ETs, which include tamoxifen, raloxifene, anastrozole, and exemestane, tamoxifen is the only one available for premenopausal women aged 35 years and older. A shared decision-making process should be used to increase the usage of ET and must be individualized. This individualized approach must account for each woman’s medical history and weigh the benefits and risks of ET in combination with the personal values of the patient.     

Chinese Breast Cancer Screening Beliefs Questionnaire: development and psychometric testing with Chinese-Australian women

Title.  Chinese Breast Cancer Screening Beliefs Questionnaire: development andpsychometric testing with Chinese-Australian women.
Aim.  This paper is a report of the development and psychometric testing of the Chinese Breast Cancer Screening Beliefs Questionnaire, a culturally sensitive questionnaire for measuring Chinese-Australian women's beliefs, knowledge and attitudes towards breast cancer and breast screening practices.
Background.  Breast cancer is the leading cause of cancer morbidity among Chinese-Australian women. They are, however, 50% less likely to participate in all types of breast examination. A valid and reliable instrument to explore the breast cancer beliefs is essential for the development of interventions to promote breast cancer screening practices.
Method.  Items for the questionnaire were drawn from a literature review and in-depth interviews. A panel of professional experts and lay women evaluated face and content validity. The instrument was translated from English to Chinese using back-translation. In 2008, a total of 292 Chinese-Australian women aged 22–78 years who were resident of Australia were included in testing the instrument. Multi-trait analysis and Cronbach's alpha were used to assess internal consistency reliability and exploratory factor analysis assessed construct validity.
Results.  The final 13-item questionnaire had satisfactory validity and internal consistency. Cronbach's alpha for the total scale was 0·76, and for the three subscales ranged from 0·70 to 0·79. Exploratory factor analysis showed that the scale reduced to three factors.
Conclusion.  Preliminary data suggest that the Chinese Breast Cancer Screening Beliefs Questionnaire is a valid, reliable and culturally sensitive instrument for the measurement of Chinese-Australian women's beliefs, knowledge and attitudes about breast cancer and breast cancer screening.     

Elderly African American women's knowledge and belief about colorectal cancer.

The purpose of this pilot study using focus groups was to 1) identify elderly African American women's knowledge and belief about colorectal cancer, 2) determine whether African American elderly women seek preventative measures for colorectal cancer, and 3) determine the educational needs to increase participation in colon cancer screening. The author used a convenience sample of 15 African-American women between the ages of 45-69 recruited from a moderately large church in a major urban city. Results of the study showed that there was a very low level of participation in colon cancer screening among the women in the group. Over 70 percent had a college degree or higher and 62 percent had no knowledge about colorectal cancer. 77 percent were employed with 69 percent having health insurance; 38 percent did not perceive themselves at any risk for colorectal cancer; and only 23 percent stated that they had been tested for colon cancer. Reasons for not getting screened were: fear; afraid of pain; doctor never recommended any tests; had no symptoms; competing health histories; embarrassment; and flaws in risk perception.