Black Women, Women Living in Poverty Less Likely to Recognize Barriers to Breast Cancer Screening, So They Don’t Take Advantage of Patient Navigation for Optimal Care

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At Breastcancer.org, we believe that a woman’s best chance for early detection of breast cancer requires coordination of current screening tools:

  • high-quality mammography
  • clinical breast exam
  • breast self-exam

To not use all three tools misses opportunities for early detection.

A study has found that black women and women living in poverty are less likely to report facing barriers to having a screening mammogram. Because no barriers were reported, the women didn’t receive any extra support or help to get a mammogram, even if they needed that extra help.

The research was published online on Sept. 24, 2018, by the journal Cancer. Read the abstract of “Gendered and Racialized Social Expectations, Barriers, and Delayed Breast Cancer Diagnosis.”

Black women are more likely to be diagnosed with breast cancer that is at a later stage compared to white women. To find out why, researchers are looking at a number of factors, including the biology of the cancer, access to screening and treatment, and women’s values and their perception of the healthcare system.

In this study, called the Patient Navigation in Medically Underserved Areas study, women were randomly assigned to one of two groups:

  • one group received support from a nurse navigator when trying to schedule a screening mammogram
  • one group did not receive help from a nurse navigator

Of the 3,754 women who received support from a nurse navigator, 14% said they faced one or more barriers to getting a screening mammogram. When a woman reported a barrier, she received more support from the nurse navigator.

As a result of this additional support, women who reported barriers ultimately were more likely to have a screening mammogram compared to women who reported no barriers.

The researchers found that black women, women living in poverty, and women who said they did not trust the healthcare system were the least likely to report barriers to breast cancer screening and so were less likely to receive additional support.

The researchers pointed out that women must first recognize that they are facing a barrier to screening before they can report it.

"Our findings suggest that black women and women living in poverty, who need patient navigation interventions the most, are in fact less likely to report their barriers to optimal care," said Sage Kim, Ph.D., of the University of Illinois at Chicago’s School of Public Health. "Perhaps women who do not trust the healthcare system may not feel comfortable telling care providers about their barriers that could potentially affect the ways in which they engage in healthcare."

She added that although patient navigation is known to be effective, it is important to understand how minority women and women living in difficult life circumstances interact with this intervention and improve services accordingly. "If we don't, providers may have a false sense of security," Kim said. "They might incorrectly assume that women who do not report barriers are not in need of patient navigator support and are all doing well."

If you're 40 or older and have an average risk of breast cancer, yearly screening mammograms should be part of your healthcare. If your breast cancer risk is higher than average, you should talk to your doctor about a more aggressive breast cancer screening plan that makes the most sense for your particular situation.

There's only one of you, and you deserve the best care possible. Don't let any barriers get in the way of your regular screening mammograms:

  • If you're worried about cost, talk to your doctor, a local hospital social worker, a nurse navigator, or staff members at a mammogram center. Ask about free programs in your area.
  • If you're having problems scheduling a mammogram, call the National Cancer Institute (800-4-CANCER) or the American College of Radiology (800-227-5463) to find certified mammogram providers near you.
  • If you find mammograms painful, ask the mammography center staff members how the experience can be made as easy and as comfortable as possible for you.

For more information on mammograms and other tests to detect breast cancer, visit the Breastcancer.org Breast Cancer Tests: Screening, Diagnosis, and Monitoring pages.


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