Knowledge, Cancer Fatalism and Spirituality as Predictors of

Breast Cancer Screening Practices forAfrican American and Caucasian Women

Staci T. Anderson, PhD, RN

April 11, 2008

Background

• Breast cancer is the 2nd most frequently diagnosed cancer in women.

• In 2007, an estimated 178,480 new cases of breast cancer will be diagnosed

• African American (AA) women die from breast cancer more than any other racial group

• Use of breast cancer screening practices influences mortality and survival rates

Breast Cancer IncidenceAge-Adjusted (per 100,000)

114.2

141.5

119.5

136.8

119.2

125.7

0

20

40

60

80

100

120

140

160

2001 2002 2003

AAW

CW

(National Center for Health Statistics, 2006)

Survival Rates

(National Center for Health Statistics, 2006)

71.6

86.7

72.9

88

77.3

90.1

0102030405060708090

100

90-92 93-95 96-2002

AAW

CW

5-Year Relative Survival RatesP

erce

nta

ge

of

Wo

men

Trends in Mortality Rates

31.732.1

38.1

33.2 34.5

26.3

32.2

23.9

05

101520253035404550

1980 1990 2000 2004

AAW

CW

(National Center for Health Statistics, 2006)

Age-Adjusted RatesP

er 1

00,0

00

Louisiana Trends

123.7

121.6

122

40.3

25.7

29.8

0

20

40

60

80

100

120

140

Incidence Mortality

AAW

CW

All Women

(NCI SEER State Cancer Profile, 2006)

(per 100,000)P

er 1

00,0

00

Mammography Screening Trends

(Centers for Disease Control and Prevention, 2005)

Breast Cancer Screening

• Barriers– Structural Barriers– Organizational– Psychological

• Facilitators– Health Insurance– Source of Health Care– Physician Recommendation

Problem Statement

• Despite improvements in mammography screening rates, differences in breast cancer mortality and survival rates persist between AA and Caucasian women. Differences in utilization of breast cancer screening practices has been identified as a contributing factor to this phenomenon. Various complex and interrelated factors influence participation in breast cancer screening practices.

Purpose

• To explore relationships between knowledge related to breast cancer screening and detection, cancer fatalism, spirituality and breast cancer screening practices in African American and Caucasian women.

• To determine the ability of these variables to predict breast cancer screening practices in African American and Caucasian women.

Significance

• Findings could be used to develop more culturally specific educational interventions.

• Health care providers need to be aware of an individual’s knowledge, perceptions, beliefs, and attitudes about breast cancer.

Study Variables

• Breast Cancer Knowledge– Cognitive information about breast cancer and

breast cancer detection and screening practices

• Breast Cancer Screening Practices– Methods used to detect breast cancer in

persons who are asymptomatic.• BSE• CBE• Mammogram

Research Hypotheses

H1 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in AA women.

H2 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in Caucasian women.

Research Hypotheses

H3 Breast cancer knowledge is a predictor of breast cancer screening practices in AA women.

H4 Breast cancer knowledge is a predictor of breast cancer screening practices in Caucasian women.

Methodology

• Study Design– Multicorrelational cross-sectional research

design

• Sampling– Non-probability convenience sample– Inclusion/exclusion criteria

• Instruments

Measurements• Breast Cancer Knowledge Test (BCK)

(McCance et al., 1990)– Measures knowledge of detection and

screening practices– Higher scores associated with greater

knowledge

• Demographic Questionnaire

Demographic Characteristics

• Race – 53.7% AA; 46.3% Caucasian

• Age – 44.7 ± 12.8

• Marital Status – 48.8% Married

• 63.6% Annual Income ≥ $50,000

• Education– 37.7% College Graduate– 18.5% Completed Graduate School

Demographic Characteristics

• Health Resource Variables– Health Insurance Coverage - 94.4%– Usual Source of Care – 90.1%

• Health History– Family history of BC diagnosis (n = 58)

• 43.1% Participates in BCSP

– Family history of BC death (n = 28)• 46.4% Participates in BCSP

Breast Cancer Screening Practices

AA

(n=87)

Caucasian

(n=75)Total

(n=162)

Participates 39

44.8%

27

36.0%

66

40.7%

Does not Participate 48

55.2%

48

64.0%

96

59.3%

Breast Cancer Knowledge

AA

(n=87)

M

Caucasian

(n=75)

M

Total

(n=162)

M

Participates 13.77 14.56 14.09

Does not Participate 12.35 14.21 13.28

H1 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in AA women.

Breast Cancer Knowledge

Breast CancerScreening Practices

Limited Extensive Total

n % n % n %

Participates 17 37.0 22 53.7 39 44.8

Does Not Participate 29 63.0 19 46.3 48 55.2

Totals 46 100.0 41 100.0 87 100.0

X2 = 1.816; df = 1; p = .178

H2 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in Caucasian women.

Breast Cancer Knowledge

Breast CancerScreening Practices

Limited Extensive Total

n % n % n %

Participates 8 32.0 19 38.0 27 36.0

Does Not Participate 17 68.0 31 62.0 48 64.0

Totals 25 100.0 50 100.0 75 100.0

X2 = .065; df = 1; p = .799

H3 Breast cancer knowledge is a predictor of breast cancer screening practices in AA

women.

Variable b Beta Sig PercentExplained

Breast Cancer Knowledge

.042 .244 .022 6.0

Constant -.100 -- --

Multiple R

R2

.244

.060

Total variance explained = 6.0%; variance unexplained = 94.0%.

H4 Breast cancer knowledge is a predictor of breast cancer screening practices in

Caucasian women.

Variable b Beta Sig PercentExplained

Breast Cancer Knowledge

.021 .092 .452 --

Constant -.080 -- --

Multiple R

R2

.099

.010

Total variance explained = 0.0%; variance unexplained = 100.0%.

Discussion/Conclusions

• Breast Cancer Screening Practices

• Breast Cancer Knowledge– No significant relationship found– Caucasian women had higher mean scores

• Demographics– Income– Education– Health Resources

Implications

• Nursing Research

• Nursing Practice

• Nursing Education– Health & Wellness Model

• Health Policy– Policy Initiatives– Funding for Research

Limitations

• Use of self-report data• Non-probability convenience sample• Recruitment settings• Variability of study participants

Recommendations

• Study designed to determine breast cancer screening practices over time utilizing a larger and ethnically diverse sample

• Secondary analysis to determine if there are relationships between demographic variables, spirituality, and each method of breast cancer early detection

• Develop and test culturally specific interventions that focus on increasing breast health and breast cancer screening practices

THANK YOU!

QUESTIONS?