A Comparison of Compliance and Non-Compliance in Breast Cancer Screening Among African American Women

Introduction: African American women have the lowest breast cancer survival rate of any racial or ethnic group, due partially from late stage diagnosis. Early detection is a key factor in increasing breast cancer survival rates. The American Cancer Society recommends that women receive an annual mammogram beginning at 40 years of age. The purpose of the current study was to explore differences among African American women who were compliant and non-compliant with mammography screening recommendations.

Methods:  A survey research design consisting of face-to-face structured interviews was utilized with a purposive sample of African-American women attending breast cancer awareness events at local churches in an underserved urban area. Interviews were conducted by trained research assistants before the start of each event. The questionnaire included demographic data, health data, screening history, and factors related to screening behavior. A total of 462 African American women met the inclusion criteria of over 40 years of age with no prior history of cancer. Seventy-three percent of respondents reported they had a mammogram in the past year (N=352) and 24% reported they did not have a mammogram in the past year (N=110). The mean age of the sample was 57 years (SD=10.59), with no significant difference in age amongst the two groups (t=3.47).

Results:  Bivariate analyses were used to compare women who did and did not report having a mammogram in the past year. No difference was reported regarding having a relative diagnosed with breast cancer (x²=3.47). Findings did reveal that those women not having a mammogram last year were significantly less likely to have health insurance (x²=25.50, p=.001), a clinical breast exam by a medical professional (x²=50.10, p=.001), or ever had a mammogram (x²=41.32, p=.001). There were no difference between the number of visits to a doctor during the past 12 months (t=2.19); however, those women who did not have a mammogram were significantly less likely to have had a clinical breast exam at their last check-up (x²=15.60, p=.001) and less likely to be told by their doctor to get a mammogram (x²=52.45, p=.001).  Results showed that women who did not get a mammogram were significantly more likely to be concerned about radiation (x²=23.98, p=.001), pain (x²=52.45, p=.001), time to get screened (x²=40.26, p=.001), transportation (x²=20.47, p=.001), and not having insurance (x²=26.72, p=.001). Lastly, findings revealed that those not getting a mammogram in the past year were significantly less likely to plan to schedule a mammogram next year (x²=33.80, p=.001), 

Implications: There are several key stakeholders in the fight against breast cancer. Social workers have the values, training, and skills to assume a leading role in improving the compliance rates for breast cancer screening among African Americans. Within a collaborative care structure, social workers can help education health care professionals on the importance of addressing breast cancer screening at each visit and preforming a clinical breast exam. Furthermore, it is essential for key stakeholders to address the barriers that may be preventing African American women from getting a mammogram.