ArticleFactors that Influence Mammography Use for Breast Cancer Screening among African American Women
Introduction
In the United States, breast cancer is the second leading cause of cancer death among women. The American Cancer Society (ACS) estimates that in 2018, there will be 268,670 new breast cancer cases with a projected death count of 41,400.1 Among African American women, breast cancer is the most commonly diagnosed type of cancer.2 Despite substantial developments in breast cancer prevention and early detection, black women still bear an uneven burden of breast cancer mortality.3 While overall incidence rates are slightly lower among African American women compared to white women, African American women have higher mortality rates than white women. During 2005–2011, the five-year survival rates for breast cancer was lower for African American women (80%) than white women (91%).2
Although African American women present with more aggressive cancers in comparison to white women, survival disparities have been shown to remain even after stage and tumor characteristics are accounted for. This indicates that the inequalities might also be attributable to non-clinical factors.4 Some factors known to contribute to the higher mortality rate among African American women include socioeconomic factors, biological factors, lack of access to care and timely treatment.5 Extant studies that have examined mammography screening decisions in African American women have found that sociodemographic, structural3 and cultural factors6,7 are important. Furthermore, studies have also revealed that delay in care utilization after symptom detection is a significant factor in the higher mortality rate in African American women.8 Attempts to improve breast cancer screening have focused on routine mammography for early detection and timely referral. Routine screening detects breast cancer at a timely and treatable stage and is a key factor in reducing mortality.9 The U.S Preventive Services Task Force (USPSTF) currently recommends biennial screening mammography for women aged 50–74 years,10 while the ACS strongly recommends beginning regular screening at age 45.11 The ACS guidelines for breast cancer screening can be found in Table 1.
Historically, white women have utilized mammography at higher rates compared to black women. In recent years, however, some data show that African American women utilize mammograms at similar rates with white women.12 Seemingly, mammography utilization gaps between African American and white women could be closing. Nevertheless, presentation and outcome differences persist; and the extent of unmet needs among African American women is unknown, hence there is a need to assess mammography screening behaviors and associated factors in this population.
Section snippets
Purpose
Understanding the factors that influence breast cancer early detection and care utilization will help reduce disparities and possibly identify factors that can be modified via interventions. This is also aligned with Healthy People 2020 objectives to reduce breast cancer death rates13 and increase access to health services.14
The purpose of this paper was to synthesize findings from recently published studies that assessed factors associated with breast cancer screening and repeat mammography
Data sources
The core search for this study was conducted in four widely used databases: PubMed, CINAHL, Psych INFO and Web of Science. Search terms included a combination of the following words using Boolean operators: breast cancer screening, mammography, repeat mammography and African American. Lists of cited references from the studies included in the review were also assessed.
Eligibility criteria
To be included in this review, articles had to: a) have examined factors associated with mammography screening; b) include
Study characteristics
Overall, 24 articles met the inclusion/exclusion criteria. Studies were published between 2005 and 2017 with majority appearing between 2005 and 2008. A total of 23 studies were exclusively based on African American women while one study had a sample that was 96% African American. Only one author [namely, Davis et al. (n = 2)] published more than one study on the topic. A total of 11 articles used a theoretical framework, with the most frequent being the Health Belief Model, which is widely
Predisposing factors
A total of seven predisposing factors were identified in this review, with the most frequently identified being beliefs, closely followed by fear and fatalism. The factors education and knowledge had a positive influence on mammography use, while medical mistrust had a negative influence. However, the factors age, beliefs, religiosity and fear and fatalism had both positive and negative influences on mammography use.
Enabling factors
Four enabling factors were identified, which were all facilitators of mammography use. Among the reviewed studies, insurance coverage emerged as the strongest factor associated with mammography use.
Need factors
Four need factors were identified in this review, with physician recommendation being the most common. While the factors physician recommendation and personal and family history facilitated use of mammography screening, the factors pain and discomfort and roles of responsibility were deterrents to mammography screening in the population.
Methodological quality assessment
The raters reached an agreement rate of 85.8%. The methodological quality of the studies varied. The mean MQS was 12.2 (SD = 3.8), showing that the studies were above average in quality. Studies varied within a range of 5–18, with none of the studies having the highest possible score. Almost half of the articles (N = 11) had a theoretical framework guiding the study. A majority of the studies employed a cross-sectional design (N = 20), with only a few studies employing prospective or
Discussion
The purpose of this review was to synthesize evidence from published articles assessing factors that influence breast cancer screening among African American women. Using the ABM, this review identified 15 factors which were grouped as predisposing, enabling and need factors. All of the identified factors, apart from age and personal or family history of breast cancer, are modifiable.
Conclusions
This review pinpoints factors that influence mammography utilization among African American women in the United States. This article extends research by i) using a theoretical framework to organize findings from published studies ii) including social and cultural factors in the synthesis iii) assessing both facilitators and barriers that influence mammography use and iv) assessing the methodological quality of the studies. Our findings show that the influences are multifactorial, which
Declaration of competing interest
The authors declare that they have NO conflicts of interest.
References (53)
- et al.
Barriers related to mammography use for breast cancer screening among minority women
J Natl Med Assoc
(2010) - et al.
Breast cancer screening behaviors among African American women with a strong family history of breast cancer
Prev Med
(2006) - et al.
Predicting regular breast cancer screening in African-American women with a family history of breast cancer
J Natl Med Assoc
(2008) - et al.
Social determinants of breast cancer screening in urban primary care practices: a community-engaged formative study
Wom Health Issues
(2012) - et al.
Cancer statistics, 2018. CA: A Cancer Journal for Clinicians
(2018) Cancer facts & figures for African Americans 2016–2018, pp 2-12
(2016)- et al.
Message received: African American women and breast cancer screening
Health Promot Pract
(2017) - et al.
Social determinants of Black-White disparities in breast cancer mortality: a review
Cancer Epidem Prev Biomar
(2008) Intervention approaches for addressing breast cancer disparities among African American women
Ann Transl Med & Epidemiol
(2014)- et al.
Religious beliefs and breast cancer screening
J Wom Health
(2002)
Breast cancer screening and African American women: fear, fatalism, and silence. Paper presented at
Oncol Nurs Forum
The influence of spirituality and religiosity on breast cancer screening delay in African American women: application of the Theory of Reasoned Action and Planned Behavior (TRA/TPB)
ABNF J
Influence of sense of coherence, spirituality, social support and health perception on breast cancer screening motivation and behaviors in African American women
ABNF J
Final recommendation statement breast cancer screening
Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society
Jama
2016: With Chartbook on Long-Term Trends in Health
2020 topics & objectives cancer
2020 Topics & Objectives: Access to Health Services
Factors associated with colorectal cancer screening among younger African American men: a systematic review
J Health Dispar Res Pract
Academic and Entrepreneurial Research: Consequences of Diversity in Federal Evaluation Studies
Utilisation-focused Evaluation: The New Century Text
Revisiting the behavioral model and access to medical care: does it matter?
J Health Soc Behav
Re-revisiting Andersen's behavioral model of health services use: a systematic review of studies from 1998–2011
GMS Psycho-Soc-Med
Assessing the key attributes of low utilization of mammography screening and breast-self exam among African-American women
J Canc
How old are African American women when they receive their first mammogram? Results from a church-based study
J Community Health
A healthy mistrust: how worldview relates to attitudes about breast cancer screening in a cross-sectional survey of low-income women
Int J Equity Health
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