The Role of Cancer Survivorship in Reducing the Breast Cancer Mortality Rate of African American Women

African American women have the highest breast cancer mortality rate among all racial and ethnic groups in the United States. Breast cancer detection procedures exist that can lead to early detection and a better survival rate. Unfortunately, African American women under utilize these procedures. Models using community health advisors (CHAs) are recognized as one successful approach to improving breast cancer screening behavior among this population. Community health advisors are community members who are trained and educated regarding breast cancer and breast cancer screening. Armed with knowledge, skills, and ongoing support CHAs educate and encourage screening in their respective communities. How life experiences may impact CHA effectiveness has not been systematically studied. Specifically, this exploratory study compares the effectiveness of African American CHAs who are and who are not cancer survivors in a southern state. This study seeks to answer whether or not cancer survivorship contributes to CHA effectiveness. The objectives of this study are to: (1) measure and compare the attitudes, beliefs, and knowledge of CHAs, (2) compare the attendance levels at training and maintenance sessions of CHAs, (3) evaluate and compare the drop-out rate of CHAs, (4) evaluate and compare the effectiveness, in terms of community contacts, of CHAs, (5) evaluate the leadership roles taken on by CHAs and (6) evaluate and compare the number of cancer screenings initiated by CHAs who are cancer survivors with those of CHAs who are not cancer survivors. Of 383 CHAs, 35 (9%) self-identified as cancer survivors. Twenty three had enough data for inclusion in the study. Matched on (a) county demographics, (b) race, (c) employment status, (d) children in or out of the home, and (e) age, 23 CHAS who were not cancer survivors served as a comparison group. The average ages of the participants were 56 and 52 respectively. Data extrapolated from a RO1 funded study, representing partnerships between five institutions in two Southern states provided the data set for the current study. Attitudes, beliefs, and knowledge were measured using an instrument developed specifically for the study. Attendance at training and monthly maintenance sessions, drop-out rates, number of community contacts, leadership roles demonstrated, and number of screenings initiated were taken from participants' files. These were measures routinely taken as part of the RO1 study. Descriptive statistics were used to compare the two groups. The Wilcoxon rank-sum test was used to compare the two groups on all measures except drop-out rates measured using a two sided z-test. The results indicate that the cancer surviving CHAs began with more cancer knowledge than the non-cancer surviving group and had attitudes conducive to engaging in breast cancer screening. Both groups attended training sessions about the same. Cancer surviving CHAs dropped out less, had more community contacts, and were more effective in initiating behaviors that lead to screening. These results indicate that cancer survivors may serve as a resource in helping oncology social workers reach African American women, providing them the awareness, education and knowledge to increase screening behaviors and potentially decrease the mortality rate.