Original ArticlesBreast cancer screening among ethnically diverse low-income women in a general hospital psychiatry clinic
Introduction
Breast cancer is the most common type of nonskin cancer and the second major cause of cancer death in women, surpassed in the latter respect only by lung cancer [1]. An estimated 176,300 new cases of invasive breast cancer will be diagnosed among women in the United States in 1999, and 43,300 women will die from this disease [1]. Despite data indicating that screening mammography is the most effective technique available for the early detection of breast cancer, most asymptomatic women, particularly low-income minority women, do not get mammograms regularly 2, 3, 4, 5. Compliance with recommended guidelines may be even lower in women with chronic mental illness which, research suggests, impairs patients’ ability to participate in decisions about their health care [6]. Thus, compliance with breast cancer screening recommendations may be compromised among women with chronic psychiatric disorders.
The American Cancer Society (ACS) provides specific screening guidelines for asymptomatic women. These include an annual mammogram beginning at age 40; a clinical breast examination (CBE) by a physician or other health care professional every 3 years for women between the ages of 20 and 39, and annually for women 40 years of age and older; and a breast self-examination (BSE) monthly for women 20 years of age and older [1].
In the present study, we utilized components of the Health Belief Model (HBM) 7, 8 to explain compliance with breast cancer screening recommendations. The HBM has been used to explain differences in compliance with breast cancer screening recommendations in nonpsychiatric populations 9, 10, 11, 12. When applied to breast cancer, the HBM predicts that a woman will be most likely to participate in screening if she believes that 1) she is susceptible to developing breast cancer, 2) the consequences of breast cancer are severe, 3) early detection will increase the probability of successful treatment, and 4) the obstacles to complying with screening recommendations can easily be overcome. A woman also will be more likely to participate in breast cancer screening if she feels confident about her own role in screening (e.g., about her BSE technique) and if there are either internal or external cues to action, such as encouragement by a physician and/or the media.
Consistent with the HBM, positive relationships have been found between compliance and perceived susceptibility to and benefits of early detection of breast cancer, knowledge about breast cancer, family history of breast cancer, regularity of medical checkups, physician referral for mammography, education, and income. Negative relationships have been found between compliance and perceived barriers to screening 5, 9, 10, 12, 13.
We examined correlates of breast cancer screening behaviors among an ethnically diverse sample of low-income women with psychiatric disorders. We hypothesized positive relationships between self-reported breast cancer screening behaviors and psychiatric status, breast cancer knowledge, perceived susceptibility to or risk of developing breast cancer, confidence in performing BSE (self-efficacy), and physician recommendation of screening. We also examined the relationship of screening behaviors to race/ethnicity, education, marital status, and family history of breast cancer.
Section snippets
Participants
Participants were 121 English-speaking, adult, female, psychiatric patients attending the psychiatry outpatient clinic of a county general hospital in Houston, Texas. This hospital serves mainly indigent patients. Patients enrolled in the psychiatry outpatient clinic are referred from the medical, surgical, and psychiatric services of the hospital.
Procedures
The Baylor College of Medicine Institutional Review Board approved the study and consent procedures. Potential participants were identified as they
Participant characteristics
Table 2 shows the demographic characteristics of participants included in the present study. Approximately 85% had had a medical checkup in the past 12 months. Major Depressive Disorder (47%) was the most frequently diagnosed psychiatric disorder, followed by Anxiety Disorder (16%) and Bipolar Disorder (11%). Ten percent of the patients had diagnoses of either Schizophrenia or Schizoaffective Disorder. Mean GAF score was 47.16 (SD = 19.33, range = 10–90), indicating that the average patient
Discussion
A number of factors were related to breast cancer screening in this sample of ethnically diverse low-income women attending a general hospital psychiatry clinic. Women who had obtained mammograms and CBEs in the preceding year were more likely to have had a mammogram recommended by a physician during the same time period than those who did not. Women who had mammograms in the preceding year were less knowledgeable about breast cancer than those who did not have mammograms. Women who performed
References (28)
- et al.
Family planning needs of male chronic mental patients in the general hospital psychiatry clinic
Gen Hospital Psychiatry
(1994) - et al.
Exploration of factors affecting mammography behaviors
Prev Med
(1988) - et al.
Factors associated with repeat adherence to breast cancer screening
Prev Med
(1990) - et al.
Dispositional optimism, self-efficacy, and health beliefs as predictors of breast self-examination
Am J Prev Med
(1994) - et al.
Breast cancer screening behaviors and intentions among asymptomatic women 50 years of age and older
Am J Prev Med
(1995) - et al.
The accuracy of patient reports of a family history of cancer
J Chronic Diseases
(1985) - American Cancer Society: Cancer Facts and Figures-1999. Atlanta, American Cancer Society, Inc,...
- et al.
Who gets screened for cervical and breast cancer? Results from a new national survey
Arch Intern Med
(1988) Screening mammography a missed clinical opportunity? Results of the NCI Breast Cancer Screening Consortium and National Health Interview Survey Studies
JAMA
(1990)- et al.
Predictors of adoption of mammography in women under age 50
Health Psychol
(1995)
Early breast cancer detection behaviors among ethnically diverse low-income women
Psychooncology
The Health Belief Modela decade later
Health Educ Q
Sociobehavioral determinants of compliance with health and medical care recommendations
Med Care
Health beliefs and compliance with mammography screening recommendations in asymptomatic women
Health Psychol
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