Breast Cancer Screening Behaviors of African American Women: A Comprehensive Review, Analysis, and Critique of Nursing Research

By Conway-Phillips, Regina; Millon-Underwood, Sandra | ABNF Journal, Fall 2009 | Go to article overview

Breast Cancer Screening Behaviors of African American Women: A Comprehensive Review, Analysis, and Critique of Nursing Research


Conway-Phillips, Regina, Millon-Underwood, Sandra, ABNF Journal


Abstract: Breast cancer is particularly burdensome on African American women (AAW) ranking second among the cause of cancer deaths in AAW. Although the incidence of breast cancer is highest in White women, AAW have a higher breast cancer mortality rate at every age and a lower survival rate than any other racial or ethnic group. Statistics indicate that the gap is widening. The results of several studies suggest that breast cancer mortality among AAW would be reduced if breast cancer screening recommendations were more effectively utilized. Results of research studies aimed at identifying variables relating to AAW acceptance of breast cancer screening activities have not had an impact on the disparity in mortality rates. The goals of this paper are to summarize the accumulated state of the nursing science and knowledge concerning breast cancer screening behavior of African American women, and to highlight important issues that research has left unresolved.

Key Words: African American women, breast cancer screening, breast neoplasms, mammography.

Breast cancer is particularly burdensome on African American women (AAW). Although the incidence of breast cancer is highest in White women, AAW have a higher breast cancer mortality rate than any other racial or ethnic group at every age (American Cancer Society, 2007a). Mortality rates among AAW are approximately 10 percent higher than White women. The five-year survival rate for breast cancer among AAW is 73% compared to 88% among White women (American Cancer Society, 2007b).

Despite a surplus of programs aimed at increasing breast cancer screening rates among AAW and research studies aimed at identifying variables that relate to AAW compliance and acceptance of breast cancer screening activities (U.S. Department of Health and Human Services, 2005; Underwood & Dobson, 2004) the gap in the mortality rates between AAW and White women continues to widen with minimal explanation as to why. This is indicative of an apparent gap in research in this body of knowledge.

The nursing discipline has made significant contributions to this body of research, however, little is known about the scope, quality and potential impact these studies have had on reducing the disparity in breast cancer mortality and morbidity experienced by AAW (Underwood et al., 2005). The goals of this paper are to summarize the accumulated state of the science and knowledge concerning breast cancer screening behavior of African American women, and to highlight important issues that research has left unresolved.

Conceptualization of Breast Cancer Screening

Mammography, breast self examination (BSE); and clinical breast examinations (CBE) by a medical practitioner are frequently identified as the three primary tools of breast cancer screening (Centers for Disease Control and Prevention [CDC], 2007a). Several institutions and organizations have developed recommendations and guidelines for breast cancer screening. The guidelines and recommendations vary somewhat among the organizations, however, the ACS recommends yearly mammograms starting at age 40 and continuing for as long as a woman is in good health; clinical breast examinations every three years for women 20 to 30 years of age and every year for women 40 years of age and over; and beginning in their 20s, women should be informed about the benefits and limitations of BSE and should know how their breast normally feel and report any changes to their health care providers (American Cancer Society, 2007b).

Breast Cancer Screening in African American Women

Breast cancer screening and early detection are key factors in reducing mortality, since breast cancer is more easily treated and controllable if it is found early. Mammography is the best available method to detect breast cancer in its earliest, most treatable stage (Institute of Medicine, 2003).

The data reflective of AAW and White women's utilization of mammograms are inconsistent, with some reporting higher utilization rates among AAW while others report lower rates. …

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