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Women's Health

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Negative attitudes about mammography lead some low-income black women to skip their appointments to have the procedure

Breast cancer is the second leading cause of cancer deaths among black women today. Unfortunately, black women tend to have low mammography screening rates, which plays a role in delayed diagnosis leading to a disproportionate number of deaths from breast cancer among black women. A recent study supported in part by the Agency for Healthcare Research and Quality (HS07400) reveals that knowledge of screening recommendations and access to free mammograms often are not enough to get poor black women to keep mammogram appointments. Negative attitudes and other factors also play a role in black women's failure to keep appointments for screening mammography.

Despite referrals by a clinician for a mammogram, knowledge of mammogram screening recommendations, and access to low-cost or free mammography services, women harboring negative attitudes were more likely than other women to miss mammogram appointments. These were women who believed that getting a mammogram was embarrassing or was unnecessary in the absence of symptoms. Women who had no history of a benign breast mass were also more likely to miss mammogram appointments. Knowledge of breast cancer screening recommendations had no impact on missed appointments.

Age was inversely related to appointment compliance; women aged 70 and older were less likely to miss a mammogram appointment compared with women 40 to 49 years of age. Also, women referred for a mammogram by a nurse practitioner or physician's assistant (who may have more effective communication styles than doctors) were 70 percent less likely to miss their appointments than women who were referred by a physician.

Based on these study findings, the Morehouse School of Medicine researchers conclude that health education strategies need to address breast cancer screening attitudes among women as well as their knowledge. In addition, physicians need to more effectively encourage mammography, and health care systems should incorporate reminder systems into their services. The researchers interviewed 574 low-income black women with screening mammogram appointments at an urban hospital to determine predictors of mammogram appointment noncompliance.

See "Factors related to noncompliance with screening mammogram appointments among low-income African-American women," by Sherry R. Crump, M.D., M.P.H., Robert M. Mayberry, M.P.H., Ph.D., Beverly D. Taylor, M.D., and others, in the May 2000 Journal of the National Medical Association 92, pp. 237-246.

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