Mistrust, costs reduce breast cancer screening among minorities

Distrust of healthcare providers, cultural barriers, lack of information about the benefits of screening, or simply the need to cut corners might all contribute to the levels of compliance for breast cancer screening among minorities, including African American, Hispanic, and lesbian/bisexual women, recent studies show.

In one of the studies, Michigan State University researchers found that more than two-thirds of minority women believe that healthcare organizations sometimes mislead or even purposely deceive patients. This perception, among a series of other factors, may be preventing these women from getting breast cancer screenings, said principal investigator Dr. Karen Patricia Williams, an assistant professor of ob/gyn and reproductive biology at MSU's College of Human Medicine.

Based on interviews with 341 women, Williams and colleagues found that 39% African American women expressed distrust. About 15% of Latinas and 9% of Arab-American women said they were suspicious.

Nearly half of all women in the study who had never undergone mammography screening said they believe medical organizations have experimented on patients without their knowledge. And almost two-thirds of women who had not received a breast exam in the last year agreed they are not sure if care providers really know what they are doing. Another significant finding of the study was that many minority women will use health services only when they are sick.

In a separate study involving 652 subjects, University of Arizona researchers determined that most breast cancers in Hispanic women are detected by self-examination. Although screening mammography rates were high for subjects born in the U.S. (83%) and in Mexico (62%), only 23% of cancers were discovered by mammography and 6% through a clinical exam. Palpation was used to diagnose two-thirds of breast cancers.

Half of the women with suspected breast cancer waited at least one month before seeking medical help, said study author Rachel Zenuk, a graduate student at the University of Arizona Cancer Center in Tucson. The delays were attributed to the lack of health insurance among Hispanic women.

Both studies were presented at the 2009 American Association for Cancer Research Conference on the Science of Cancer Health Disparities, in Carefree, AZ.

A third study, published in the Journal of Women's Health, assessed the attitudes toward screening of 150 lesbian/bisexual and 400 heterosexual women. It revealed negative beliefs about mammography, lower levels of provider trust, and less perceived risk of breast cancer among lesbian/bisexual women (Feb. 2009;18[2]:177-185).

The studies may not be conclusive, but they underscore the complex dynamics that characterize different communities, their culture, perceptions about medical practice, and the hard economic times many women in general are going through, said Dr. Stamatia Destounis, a radiologist at the Elizabeth Wende Breast Clinic in Rochester, NY.

Women in many countries, for instance, face the possibility of having sensitive personal information mishandled. Sometimes they have not been exposed to the same level of preventive health education that women in the U.S. have, she said.

"There's always a little mistrust," Destounis told Diagnostic Imaging. "But it's all part of the education process. People who are not educated in this process will get there -- it'll just take longer."

The studies suggest, however, that economic hardship is a more troubling sign to look at, Destounis said. Everyone across the board, not just minorities, could be affected.

"If the recession continues, more women are going to lose their insurance or drop it because of high deductibles," she said.