Abstract: African American women (AAW) are 25% more likely to present with late stage breast cancer and 20% more likely to die from their disease than Caucasian women. Researchers report that a treatment delay of 3 months is a significant factor in breast cancer mortality. Socioeconomic factors, lack of access and knowledge, spiritual and religious beliefs, fear and fatalism are reported as contributing factors to screening delays. Studies have primarily applied the Health Belief Model (HBM) and modified versions like the Champion HBM to preventive health practices. Neither have significant inclusion of spirituality or religiosity. The TRA/TPB focus on beliefs, intent and attitude as individual determinants of the likelihood of performing a specific behavior; but have not had wide utility in studies related to screening delays among AAW. This paper explores the utility of applying the TRA/TPB as the theoretical framework for determining cultural relevance of spirituality and religiosity to screening delays among AAW.
Key Words: African American Women; Breast Cancer; Spirituality; Religiosity; Theory of Reasoned Action and Planned behavior (TRA/TPB).
The American Cancer Society (ACS) estimates that in 2005, there will be 211,240 new female breast cancer cases in the United States, with an estimated death rate of 40,870 (Jemal, Murray, Ward, Samuels, Tiwari, Ghafoor et al., 2005). Despite gains in reducing screening disparities, the mortality from breast cancer continues to be higher among African American women. Specifically, among African American women, breast cancer is the most common cancer diagnosed and accounts for 29% of new cases and 18.4% of cancer deaths (Cancer Facts & Figures for African Americans 2005-2006). The overall incidence rate of breast cancer is about 17% lower in African Americas women than in white women; However, among younger African American women (under the age of 40), the incidence rate is higher than among white women (Cancer Facts & Figures for African Americans 2005-2006). African American women are 25% more likely than white women to have late-stage breast cancer at the time of diagnosis (Mandelblatt, Andrews, Kao, Wallace & Kerner, 1995). Breast cancer incidence rates are lower among African American women than for Caucasian women; however, African-American women have a 20% higher mortality rate (Jemal et al., 2005). Delay in the decision to participate in breast cancer screening has been cited in the literature as a contributing factor of late stage of disease at diagnosis, which has implications for increased breast cancer mortality (Bradley, 2005; Burgess et al., 2001; Facione et al., 2002; Nosarti et al., 2000; Caplan, 1995; Caplan et al., 1996).
Race, ethnicity and socioeconomic factors have all been identified as contributing factors to breast cancer mortality among African American women (Burgess, Hunter, & Ramirez, 2001; Perkins, Cooksley & Cox, 1996). Studies have also cited age, lack of access, lack of knowledge, spiritual and religious beliefs, fatalism, failure to understand the seriousness of breast changes and fear as other factors contributing to delay in early screening by AfricanAmerican women (Mitchell, Lannin, Matthews & Swenson, 2002; Phillips, Cohen & Moses, 1999; Powe, 2001).
FACTORS ASSOCIATED WITH BREAST CANCER SCREENING DELAY
Qualitative and quantitative studies, both descriptive and exploratory have been conducted in an effort to identify and explain the high mortality from breast cancer in African American women. Numerous studies have been conducted related to breast cancer screening delays and lack of adherence to the ACS breast cancer screening guidelines and their association with late stage of breast cancer among African American women (Bradley, 2005; Nosarti, Crayford, Roberts et al., 2000; Caplan & Helzlsouer, 1992; O'Malley, Forrest & Mandelblatt, 2002; Burgess, Hunter & Ramirez, 2001; Facione, Miaskowski, Dodd & Paul, 2002). …