Barriers preclude rural women from breast cancer screening

While breast cancer screening in rural America remains underutilized, barriers to screening mammography in poor, rural areas are marked by significant racial disparities, according to a new study. These barriers include poor knowledge about breast cancer and screening, difficulty accessing facilities, and lack of encouragement and funds to get screened. These factors are particularly striking among Native Americans. The study will be published in the December 1, 2004 issue of CANCER, a peer-reviewed journal of the American Cancer Society. A free abstract of this study will be available via the CANCER News Room upon online publication.

Recent advances in breast cancer screening and treatments have led to an important reduction in death rates from breast cancer in American women in recent years. While early detection has been shown to reduce breast cancer deaths, its impact on mortality rates across the nation depends on large numbers of women getting screened. Current screening rates approaches 40 percent of eligible women, far less than the national goal of 80 percent. Women in rural America, particularly from minority groups, have even lower utilization rates.

In 1996 an intervention designed to increase screening among low-income women called the Robeson County Outreach Screening and Education (ROSE) Project began in North Carolina. This community-based education project targeted Caucasian, African-American, and Native American women over 40 years old. In this study Electra D. Paskett, Ph.D., Director of Center for Population Health and Health Disparities at the Ohio State University Comprehensive Cancer Center, and her colleagues characterized and compared the baseline knowledge, beliefs, and behaviors about breast cancer screening among 897 women enrolled in this project.

African-American women and, to a significantly greater extent, Native American women had less information and more inaccurate beliefs about screening compared to Caucasian women. For example, 43 percent of women did not identify “mammogram” as a breast cancer screening test, with a significantly larger proportion of Caucasians (70 percent) able to do so. African-Americans reported less self-perceived risk of breast cancer than other groups while Native Americans perceived greater risk than other groups.

Overall, pain, embarrassment, and lack of time were major reasons for women not electing screening, while lack of knowledge about testing options and recommendations or risk factors further promoted poor utilization. Moreover, despite most women having annual checkups by a doctor, more than two-thirds reported no encouragement or recommendation for a mammogram by their doctor.

The authors conclude that “the results point to groups of women in need of interventions to change beliefs, reduce barriers, and improve knowledge in order to improve adherence to screening guidelines.” They add, “low-income women are in need of encouragement to be screened and to be made aware of opportunities to obtain low-cost mammography.”