Mammography Escapes Poor, Rural Women

MONDAY, Oct. 25, 2004 (HealthDayNews) -- Throughout rural America, breast cancer screening is significantly underused, especially among poor minority populations, a new study finds.

According to the report, the barriers that keep poor rural women from getting mammograms include limited knowledge about breast cancer and the importance of screening, difficulty getting the procedure, lack of money, and lack of encouragement from their doctors. These barriers differ by race, the researchers found.

"This is a baseline study of a larger study," said lead researcher Electra D. Paskett, director of the Center for Population Health and Health Disparities at Ohio State University's Comprehensive Cancer Center. The goal of the larger study is to improve mammography screening among these women, she added.

"Even among poor rural women, there were differences by race," Paskett said. "Native American women were less likely to have correct knowledge about screening."

In their study, Paskett and her colleagues collected data on 897 women who participated in the Robeson County Outreach Screening and Education (ROSE) Project, which was started in 1996 in North Carolina. This project included white, black and Native American women over 40, according to the report in the Oct. 25 online issue of Cancer.

The researchers found that 43 percent of all women did not know that a mammogram is a breast cancer screening test. But 70 percent of white women knew what a mammogram is.

Black women underestimated their risk of breast cancer, while Native American women overestimated their risk, Paskett's team found.

Major reasons for not getting mammograms included pain, embarrassment and lack of time. Moreover, the lack of knowledge about screening and screening options and risk factors combined to limit women getting screened.

Most striking was that while most women had annual checkups, more than two-thirds said that their doctor did not recommend or encourage them to have a mammogram, Paskett's group found.

The researchers found similar barriers when it came to screening for cervical cancer among these poor rural women.

Many poor people see a doctor on an annual basis, Paskett said. "The number one reason that people make changes in their health behaviors is because the physician told them to," she said.

A recommendation by doctors is the best way to improve breast cancer screening, Paskett said. In addition, the use of lay health advisors is also effective in getting more women to undergo screening. These advisers can increase a woman's knowledge about breast cancer risk and the importance of screening and also help remove other barriers to screening, she said.

In addition, Paskett believes that to improve the screening among these women, messages about the need for breast cancer screening need to be tailored to individual groups.

"What might work in a white woman, even though she's a poor white woman from a rural county, might not necessarily be the answer to some of the questions of a Native American woman who's from the same poor county," Paskett said.

"This study is consistent with previous ones that reported rural, low-income women are less likely to participate in breast and cervical cancer screening when compared to other groups," said Barbara D. Powe, interim director of the Behavioral Research Center and director of the Special Populations Research Behavioral Research Center at the American Cancer Society.

The barriers to mammography such as cost, inability to access care, lack of recommendation by doctors, and embarrassment have been reported before, she added.

What is new in this study, according to Powe, is that despite the fact that all of the women were from a rural area and had a low income, there were still differences in breast cancer knowledge, attitudes and screening practices among the three racial groups.

"Health-care providers within these communities must empower and encourage women to participate in screening, provide appropriate information, and ensure that the women have access to the services within their community," Powe said.

More information

Learn about early screening for breast cancer from the American Cancer Society.