Skip to main content

Advertisement

Log in

Perceptions of Breast Cancer Treatment among African-American Women and Men: Implications for Interventions

  • Populations at Risk
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND

While breast cancer mortality has declined in recent years, the mortality gap between African-American and white women continues to grow. Current strategies to reduce this disparity focus on logistical and information needs, but contextual factors, such as concerns about racism and treatment side effects, may also represent significant barriers to improved outcomes.

OBJECTIVE

To characterize perceptions of breast cancer treatment among African-American women and men.

DESIGN

A qualitative study of African-American adults using focus group interviews.

PARTICIPANTS

Two hundred eighty women and 165 men who live in one of 15 contiguous neighborhoods on Chicago’s South Side.

APPROACH

Transcripts were systematically analyzed using qualitative techniques to identify emergent themes related to breast cancer treatment.

RESULTS

The concerns expressed most frequently were mistrust of the medical establishment and federal government, the effect of racism and lack of health insurance on quality of care, the impact of treatment on intimate relationships, and the negative effects of surgery, radiation therapy, and chemotherapy.

CONCLUSIONS

In addition to providing logistical and information support, strategies to reduce the breast cancer mortality gap should also address contextual factors important to quality of care. Specific interventions are discussed, including strategies to enhance trust, reduce race-related treatment differences, minimize the impact of treatment on intimate relationships, and reduce negative perceptions of breast cancer surgery, radiation therapy, and chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Cancer Society. Cancer Facts & Figures 2008. Atlanta: American Cancer Society; 2008.

  2. SEER Cancer Statistics Review, 1975-2005. National Cancer Institute, 2007. (Accessed October 7, 2008, at http://seer.cancer.gov/csr/1975_2005/).

  3. Hirschman J, Whitman S, Ansell D. The black:white disparity in breast cancer mortality: the example of Chicago. Cancer Causes and Control. 2007;18(3):323–33.

    Article  PubMed  Google Scholar 

  4. Peek ME, Han JH. Disparities in screening mammography: current status, interventions, and implications. J Gen Inter Med. 2004;19:184–94.

    Google Scholar 

  5. Yabroff KR, Breen N, Vernon SW, Meissner HI, Freedman AN, Ballard-Barbash R. What factors are associated with diagnostic follow-up after abnormal mammograms? Findings from a U.S. national survey. Cancer Epidemiol Biomarkers Prev. 2004;13(5):723–32.

    PubMed  Google Scholar 

  6. Sassi F, Luft HS, Guadognoli E. Reducing racial/ethnic disparities in female breast cancer: screening rates and stage at diagnosis. Am J Public Health. 2006;96(12):2165–72.

    Article  PubMed  Google Scholar 

  7. Carey LA, Perou CM, Livasy CA, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 2006;295(21):2492–502.

    Article  PubMed  CAS  Google Scholar 

  8. Li CI. Racial and ethnic disparities in breast cancer stage, treatment, and survival in the United States. Ethn Dis. 2005;15(2 Suppl 2):S5–9.

    PubMed  Google Scholar 

  9. Bickell NA, Wang JJ, Oluwole S, et al. Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol. 2006;24(9):1357–62.

    Article  PubMed  Google Scholar 

  10. Masi CM, Olopade OI. Racial and ethnic disparities in breast cancer: A multilevel perspective. Med Clin North Am. 2005;89:753–70.

    Article  PubMed  Google Scholar 

  11. McClintock MK, Conzen SD, Gehlert S, Masi C, Olopade O. Mammary cancer and social interactions: Identifying multiple environments that regulate gene expression throughout the lifespan. J Gerontol B Psych Sci Soc Sci. 2005;60(Spec No 1):32–41.

    Google Scholar 

  12. Maly RC, Leake B, Silliman RA. Health care disparities in older patients with breast carcinoma: informational support from physicians. Cancer. 2003;97:1517–27.

    Article  PubMed  Google Scholar 

  13. Katz SJ, Lantz PM, Janz NK, et al. Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol. 2005;23:5526–33.

    Article  PubMed  Google Scholar 

  14. Li CI, Malone KE, Daling JR. Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med. 2003;163:49–56.

    Article  PubMed  Google Scholar 

  15. Freeman HP, Muth BJ, Kerner JF. Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract. 1995;3:19–30.

    PubMed  CAS  Google Scholar 

  16. Ell K, Padgett D, Vourlekis B, et al. Abnormal mammogram follow-up: a pilot study in women with low income. Cancer Pract. 2002;10(3):130–8.

    Article  PubMed  Google Scholar 

  17. Goodwin JS, Satish S, Anderson ET, Nattinger AB, Freeman JL. Effect of nurse case management on the treatment of older women with breast cancer. J Am Geriatr Soc. 2003;51:1252–9.

    Article  PubMed  Google Scholar 

  18. Burhansstipanov L, Bad-Wound N, Capelouto N, et al. Culturally relevant “navigator” patient support: the Native Sisters. Cancer Pract. 1998;6(3):191–4.

    Article  PubMed  CAS  Google Scholar 

  19. Whelan T, Sawka C, Levine M, et al. Helping patients make informed choices: A randomized trial of a decision aid for adjuvant chemotherapy in lymph node-negative breast cancer. J Natl Cancer Inst. 2003;95(8):581–7.

    Article  PubMed  Google Scholar 

  20. Whelan T, Levine M, Wilan A, et al. Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: a randomized trial. JAMA. 2004;292(4):435–41.

    Article  PubMed  CAS  Google Scholar 

  21. Irwin E, Arnold A, Whelan T, Reyno LM, Crantion P. Offering a choice between two adjuvant chemotherapy regimens: a pilot study to develop a decision aid for women with breast cancer. Patient Educ Couns. 1999;37:283–91.

    Article  PubMed  CAS  Google Scholar 

  22. Goel V, Sawka CA, Thiel EC, Gort EH, O’Connor AM. Randomized trial of a patient decision aid for choice of surgical treatment for breast cancer. Med Decis Mak. 2001;21:1–6.

    CAS  Google Scholar 

  23. Siminoff LA, Gordon NH, Silverman P, Budd T. A decision aid to assist in adjuvant therapy choices for breast cancer. Psychooncology. 2006;15:1001–13.

    Article  PubMed  Google Scholar 

  24. O’Connor AM, Bennett C, Stacey D, et al. Do patient decision aids meet effectiveness criteria of the International Patient Decision Aid Standards Collaboration? A Systematic Review and Meta-analysis. Med Decis Mak. 2007;27:554–74.

    Article  Google Scholar 

  25. Masi CM, Blackman DJ, Peek ME. Interventions to enhance breast cancer screening, diagnosis, and treatment among racial and ethnic minority women. Med Care Res Rev. 2007;64(5):195S–242S.

    Article  PubMed  Google Scholar 

  26. Johnston-Polacek GNL, Ramos MC, Ferrer RL. Breast cancer disparities and decision-making among U.S. women. Patient Educ Couns. 2007;65:158–65.

    Article  Google Scholar 

  27. Mohamed IE, Williams KS, Tamburrino MB, Wrobeck JM, Carter S. Understanding locally advanced breast cancer: what influences a woman’s decision to delay treatment. Prev Med. 2005;41:399–405.

    Article  PubMed  Google Scholar 

  28. Stiggelbout AM, Jansen SJ, Otten W, Baas-Thijssen MC, van Slooten H, van de Velde CJ. How important is the opinion of significant others to cancer patients’ adjuvant chemotherapy decision-making? Support Care Cancer. 2007;15(3):319–25.

    Article  PubMed  CAS  Google Scholar 

  29. Walker D, Myrick F. Grounded theory: an exploration of process and procedure. Qual Health Res. 2006;16(4):547–59.

    Article  PubMed  Google Scholar 

  30. QRS International. NVivo 6. Melbourne; 2006.

  31. Balshem M. Cancer in the Community. Washington, D.C.: Smithsonian Institution Press; 1993.

    Google Scholar 

  32. Lannin DR, Mathews HF, Mitchell J, Swanson MS, Swanson FH, Edwards MS. Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA. 1998;1998:1801–7.

    Article  Google Scholar 

  33. Shockney L. Navigating Breast Cancer: A Guide for the Newly Diagnosed. Sudbury, MA: Jones and Bartlett Publishers, Inc.; 2007.

    Google Scholar 

  34. Hughes-Halbert C, Armstrong K, Gandy OH, Shaker L. Racial differences in trust in health care providers. Arch Intern Med. 2006;166:896–901.

    Article  Google Scholar 

  35. Jacobs EA, Rolle I, Estwing-Ferrans C, Whitaker EE, Warnecke RB. Understanding African Americans’ views of the trustworthiness of physicians. J Gen Intern Med. 2006;21:642–7.

    Article  PubMed  Google Scholar 

  36. Ashing-Giwa KT, Padilla G, Tejero J, et al. Understanding the breast cancer experience of women: a qualitative study of African-American, Asian American, Latina and Caucasian cancer survivors. Psychooncology. 2004;13:408–28.

    Article  PubMed  Google Scholar 

  37. Gamble VN. Under the shadow of Tuskegee: African Americans and Health Care. Am J Public Health. 1997;87:1773–8.

    Article  PubMed  CAS  Google Scholar 

  38. Washington HA. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. New York: Doubleday; 2006.

    Google Scholar 

  39. Salant T, Gehlert S. Collective memory, candidacy, and victimisation: community epidemiologies of breast cancer risk. Sociol Health Illn. 2008;30(4):599–615.

    PubMed  Google Scholar 

  40. Phillips JM, Cohen MZ, Moses G. Breast cancer screening and African American women: fear, fatalism, and silence. Oncol Nurs Forum. 1999;26(3):561–71.

    PubMed  CAS  Google Scholar 

  41. Bailey EJ, Erwin DO, Belin P. Using cultural beliefs and patterns to improve mammography utilisation among African American women: the Witness Project. J Natl Med Assoc. 2000;92:136–42.

    PubMed  CAS  Google Scholar 

  42. Tseng JF, Kronowitz SJ, Sun CC, et al. The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer. Cancer. 2004;101:1514–23.

    Article  PubMed  Google Scholar 

  43. Lannin DR, Mathews HF, Mitchell J, Swanson MS. Impacting cultural attitudes in African-American women to decrease breast cancer mortality. Am J Surg. 2002;184:418–23.

    Article  PubMed  Google Scholar 

  44. Soler-Vila H, Kasl SV, Jones BA. Cancer-specific beliefs and survival: a population-based study of African-American and white breast cancer patients. Cancer Causes and Control. 2005;16:105–14.

    Article  PubMed  Google Scholar 

  45. AAMC, Industry Funding of Medical Education: Report of an AAMC Task Force. Washington, D.C.: Association of American Medical Colleges; 2008:4.

  46. Balkrishnan R, Dugan E, Camacho FT, Hall MA. Trust and satisfaction with physicians, insurers, and the medical profession. Med Care. 2003;41(9):1058–64.

    Article  PubMed  Google Scholar 

  47. Doran KM, Kirley K, Barnosky AR, Williams JC, Cheng JE. Developing a novel poverty in healthcare curriculum for medical students at the University of Michigan Medical School. Acad Med. 2008;83(1):5–13.

    Article  PubMed  Google Scholar 

  48. Vela MB, Kim KE, Tang H, Chin MH. Innovative health care disparities curriculum for incoming medical students. J Gen Intern Med. 2008;23(7):1028–32.

    Article  PubMed  Google Scholar 

  49. Beach MC, Rosner M, Cooper LA, Duggan PS, Shatzer J. Can patient-centered attitudes reduce racial and ethnic disparities in care? Acad Med. 2007;82(2):193–8.

    Article  PubMed  Google Scholar 

  50. Beach MC, Gary TL, Price EG, et al. Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding provider and organization interventions. BMC Public Health 2006.

  51. Lantz PM, Weisman CS, Itani Z. A disease-specific Medicaid expansion for women: the Breast and Cervical Cancer Prevention and Treatment Act of 2000. Women’s Health Issues. 2003;13:79–92.

    Article  PubMed  Google Scholar 

  52. Shockney LD. Psycho-oncology of Breast Cancer: Progressing into Survivorship. In: Shockney LD, Tsangaris TN, eds. The Johns Hopkins Breast Cancer Handbook for Health Care Professionals. Sudbury, MA: Jones and Bartlett Publishers; 2008:312.

    Google Scholar 

Download references

Acknowledgements

This research was supported by an NIEHS/NCI Centers for Population Health and Health Disparities grant P50-ES12382 and by a grant from the American Cancer Society Illinois Division PSB-05-08. Results of this study were presented in part at the Annual Meeting of the Society of General Internal Medicine in Toronto, ON, in April 2007.

Conflict of Interest

None Disclosed.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christopher M. Masi MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Masi, C.M., Gehlert, S. Perceptions of Breast Cancer Treatment among African-American Women and Men: Implications for Interventions. J GEN INTERN MED 24, 408–414 (2009). https://doi.org/10.1007/s11606-008-0868-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0868-6

KEY WORDS

Navigation