Study examines black women’s perceptions about breast cancer

African-American women are more than twice as likely as white women to develop basal-like breast cancer, an aggressive subtype that is hard to treat. More significantly, the five-year survival rate for African-Americans with basal-like breast cancer is 78 percent, lower than that of any other ethnic or racial group in the U.S. and much lower than that of white women, who have a 90 percent survival rate.Researchers have identified important ways to prevent death from the disease, especially regular self-examination and screening and healthy lifestyle behaviors, but they continue to seek more effective ways to communicate the risk to African-American women and encourage prevention strategies.

Now, a study by a team from The University of North Carolina at Chapel Hill provides additional information about black women’s understanding of cancer and communication tools that may encourage cancer-prevention behaviors.

The study, led by Marlyn Allicock, PhD, research assistant professor of nutrition at UNC’s Gillings School of Global Public Health, appeared in the May issue of the Journal of Health Care for the Poor and Underserved.

Through interviews with 57 African-American women, ages 18 to 49, in six focus groups in central North Carolina, Allicock and colleagues explored women’s knowledge, beliefs and attitudes about breast cancer. The effort was part of a larger investigation aimed at understanding how obesity alters basal-like breast cancer risk. Focus groups were designed to help identify knowledge gaps as well as cultural considerations that must be addressed as scientific research findings are disseminated to younger African-American women.

Most of the women in the study had attended college (86 percent) and were employed (77 percent). Almost half (47 percent) had annual incomes of $40,000 or more. The authors note that women with less education and income likely have less accurate information.

Age (“Cancer only happens as you get older”), race (“Cancer is a “white person’s disease”), and lack of family history of breast cancer (“I won’t get it if my mother and grandmother didn’t”) were among the factors that gave participants the impression they were at low risk of developing the disease.

 

Sixty-four percent of the participants reported obtaining their information about cancer from the television or Internet. Several reported being moved by the candor of African-American celebrity Robin Roberts of ABC’s Good Morning America. “Before that, I never thought of getting the disease,” one woman said, “because I’d never seen anyone like me who had it.” Others reported that seeing only white women as the public face of breast cancer, including at fundraising events such as the Komen Race for the Cure,© made them feel the disease did not concern them.

 

When asked about their associations with the words “breast cancer,” responses were overwhelmingly negative, with “death” being mentioned in nearly every focus group. Comments reflected some important awarenesses, including “You’re not immune if no one in your family has it” and “Early detection makes a difference.” However, women in the study showed little knowledge about breast cancer subtypes or recognition that some cancers were more likely to kill than others. There was little awareness that obesity was a risk factor for cancer, or that breastfeeding for the recommended one year or more decreases cancer risk.

 

Participants suggested that socioeconomic status (SES) is a risk factor because women with lower SES may not have access to the same level of health care and insurance, which contributes to poor health overall. They also noted that African-American diets tended to be higher in fat and less healthy, and they identified those dietary choices as increasing cancer risk.

 

They recognized mammography and breast self-exams as core components of breast health and talked about the importance of those procedures. There was some frustration about what to look for during a self-exam and frustration with medical care providers whom they perceived to be dismissive when they reported a concern.

 

On the whole, their input emphasized that health communications should be personally relevant, culturally appropriate and convenient. Some participants suggested frequent messaging, as with public service announcements about flu vaccinations. They said convenient sources of information would include health-oriented programming at churches, local grocery stores, health fairs and workshops at their place of employment or at community-based organizations.”The roots of these inequalities [between African-American and white women] are complex and involve inequities in work, wealth, income, education, housing and overall standard of living, as well as barriers to high-quality cancer prevention, early detection and treatment services,” the authors write. “Even though there has been important progress made in terms of research and awareness about breast cancer, there is still much work to be done to address persistent cancer health disparities. Use of concrete strategies based on the suggestions of the young African-American women [in the study] should improve communication of basal-like breast cancer risk information and motivate screening behavior.”

This study is part of a larger grant, led by Gillings School co-principal investigators Melissa A. Troester, PhD, associate professor of epidemiology, and Liza Makowski, PhD, assistant professor of nutrition, and funded by the National Institute of Environmental Health Sciences, one of the National Institutes of Health. The larger study examines how factors such as pregnancy and obesity promote susceptibility to an aggressive subtype of breast cancer that is more prevalent in young African-American women.

 

Co-authors of the current study, “African-American Women’s Perspectives on Breast Cancer: Implications for Communicating Risk of Basal-like Breast Cancer,” are Neasha Graves, MPA, research associate, and Kathleen Gray, MSPH, associate director for research for the environment, both at UNC’s Institute for the Environment, and Troester, associate professor of epidemiology at the Gillings School.

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Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.