Older women lack breast cancer knowledge

Researchers offer suggestions for education

If older women knew that breast cancer isn't just a young woman's disease, that lumps can be detected by a mammogram up to two years before they can be felt, and that early detection means a good chance of a cure, perhaps they wouldn't hesitate so much to get a mammogram. But, as a new study shows, many women over 65 - especially African-Americans - don't have this knowledge. They continue to avoid the test, and women over 65 continue to account for half of U.S. breast cancer deaths each year.

Health care providers can help turn this trend around by taking a look at the erroneous beliefs, fears, and barriers that keep women from having mammograms, says Celette Sugg Skinner, PhD, assistant professor at the Washington University School of Medicine's Mallinckrodt Institute of Radiology in St. Louis. Skinner was the primary investigator in a study of the breast cancer knowledge of 253 women living in urban St. Louis that appeared recently in the American Journal of Preventive Medicine.1 She also published a paper on an innovative breast cancer education program targeted at older African-American women in Health Behavior and Education.2

"Older women, especially black women, are more likely to die from breast cancer rather than have it be a setback in an otherwise normal life," Skinner says. "We wanted to see what factors differentiated women who had mammograms vs. those who didn't. We need to understand why these women are not getting mammograms so we can design programs to help."

In the St. Louis study, only half the women had received a mammogram in the past two years, and about one-third weren't even thinking about having the test. The women shared many misconceptions about breast cancer, including thinking breast self-exams can find pea-sized lumps and that younger women are more likely to get the disease.

More than half of the women thought touching the breasts could lead to cancer, that treatments work better for younger women, and that breast cancer is painful in its earliest stages. Many did not know that having a close relative with the disease increases the risk, and some thought they weren't at risk because they had small breasts, weren't having sex, or had protected their breasts from bumping and bruising.

"These women need to understand they are at risk of breast cancer," Skinner says. "Many think that only younger women get it because those cases make the best media stories - the Murphy Brown stories. They need to know there's a great benefit of finding cancer early."

Fear holds women back

But it's not just lack of knowledge that keeps some women from making a mammogram appointment; sometimes it's fear. "Some women consider screening but think, why go looking for trouble? They're worried the result might not be good," Skinner says. "The crucial message we need to send is you don't need to be concerned about finding cancer early, you need to be concerned about finding cancer late."

Other potential barriers include thinking that mammograms are embarrassing, painful, or too difficult to arrange and attend. Skinner made an interesting observation in this study: Women who received their health care at a neighborhood or hospital clinic were more likely to have a mammogram than those seeing a private physician.

She hypothesizes that clinics are used to dealing with certain types of women and may be better at knowing how to get them through the process by making appointments or arranging transportation.

Patient education efforts should be tailored to address specific misconceptions and barriers, Skinner says. "First, you want to tell the women they don't want late-stage breast cancer to add to any problems they already have. It's relatively easy to be screened, and mammography is very effective in older women," she says. "If they wind up with late-stage breast cancer, that would be a traumatic, painful, unnecessary way to die."

References

1. Skinner, et al. Knowledge, perceptions, and mammography stages of adoption among older urban women. American Journal of Preventive Health 1998; 14:1-10.

2. Skinner, et al. Learn, share, and live: Breast cancer education for older, urban, minority women. Health Behavior and Education 1998; 25:60-78.