Diversity and Cancer Screenings

Original Article

Diversity matters: Unique populations of women and breast cancer screening

Carol Magai, Ph.D. 1 *, Nathan Consedine, Ph.D. 1, Francine Conway, Ph.D. 2, Alfred Neugut, M.D., Ph.D. 3, Clayton Culver, Ph.D. 4

1Department of Psychology, Intercultural Institute on Human Development and Aging, Long Island University, Brooklyn, New York 2Department of Psychology, Adelphi University, Garden City, New York 3Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York 4Department of Psychology, Southeastern Louisiana University, Baton Rouge, Louisiana

email: Carol Magai (cmagai@liu.edu)

*Correspondence to Carol Magai, Department of Psychology, Intercultural Institute on Human Development and Aging, 1 University Plaza, Brooklyn, NY 11201

Fax: (718) 246-6471

Abstract

BACKGROUND Ethnic differences in breast cancer screening behaviors are well established.

However, there is a lack of understanding regarding exactly what causes these differences and which characteristics in low-screening populations should be targeted in an effort to modify screening behavior.

METHODS Stratified cluster sampling was used to recruit 1364 women (ages 50-70 years) from 6 ethnic groups: African-American women; U.S.-born white women; English-speaking Caribbean, Haitian, and Dominican women; and immigrant Eastern-European women.

In interviews, respondents provided information concerning demographic and structural variables related to mammogram utilization (age, education, income, marital status, physician recommendation, access, and insurance) and a set of cognitive variables (fatalism, perception of personal risk, health beliefs concerning cancer) and socioemotional variables (stress, cancer worry, embarrassment, and pain).

RESULTS For data analysis, the authors used a 2-step logistic regression with frequency of mammograms over a 10-year period ( 4 mammograms over 10 years or 5 mammograms over 10 years) as a dependent variable.

U.S.-born African-American women and Dominican women were screened as frequently as European-American women, but the remaining minority groups were screened with less frequency.

With one exception, ethnicity ceased to predict screening frequency once cognitive and emotional variables were controlled.

CONCLUSIONS Although women from clearly operationalized ethnic groups continue to screen at rates substantially below those of the majority groups, these differences appear to be explained substantially by differences in psychologic variables.

This is encouraging because, rather than targeting culture for intervention, variables can be targeted that are amenable to change, such as emotions and beliefs.

Cancer 2004. Published 'Early View', May, 2004

Funded by: National Institute on Aging; Grant Number: KO7 AG00921 National Institutes of Health General Medical Science; Grant Number: 2SO6 GM54650 National Cancer Institute; Grant Number: 1P20 CA 91372, 1U54 CA 101388

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