Elsevier

General Hospital Psychiatry

Volume 21, Issue 5, September–October 1999, Pages 374-381
General Hospital Psychiatry

Original Articles
Breast cancer screening among ethnically diverse low-income women in a general hospital psychiatry clinic

https://doi.org/10.1016/S0163-8343(99)00036-5Get rights and content

Abstract

Most low-income minority women do not obtain screening mammography on a regular basis. Compliance with recommended breast cancer screening guidelines may be even lower in women with psychiatric illnesses. We investigated compliance with breast cancer screening guidelines among 121 ethnically diverse low-income women recruited from a general hospital psychiatry clinic. Mammography and clinical breast examination (CBE) had been obtained in the previous year by 59% and 70% of the patients 40 years of age and older, respectively. Among patients 20 years of age and older, 42% reported monthly breast self-examination (BSE). Physician recommendation of mammography was the strongest predictor of having obtained both a mammogram and a CBE within the previous year. There was an inverse relationship between breast cancer knowledge and screening mammography. Patients who were Hispanic, more educated, more confident in performing BSE, and whose physicians recommended monthly BSE were more likely to perform BSE monthly. These results highlight the importance of physician recommendation of compliance with screening guidelines for early detection of breast cancer. Because psychiatric patients typically are treated by psychiatrists on a regular and frequent basis, psychiatrists are in a unique position not only to encourage cancer screening but also to monitor patient compliance with their recommendations.

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

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