Gendered and racialized social expectations, barriers, and delayed breast cancer diagnosis

• Published in: Cancer Vol. 124; no. 22; pp. 4350 - 4357
• Main Authors: Kim, Sage J., Glassgow, Anne Elizabeth, Watson, Karriem S., Molina, Yamile, Calhoun, Elizabeth A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.11.2018
• Subjects: African Americans - statistics & numerical data; barriers; Breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - ethnology; Cancer; Chicago - ethnology; Delayed Diagnosis - statistics & numerical data; diagnostic mammography; distrust; Early Detection of Cancer; Female; gendered social norms; health disparity; Health Services Accessibility; Humans; Intervention; Mammography; Mammography - statistics & numerical data; Mass Screening; Medical diagnosis; Medically Underserved Area; Middle Aged; Oncology; Patient Navigation - methods; Poverty; Program Evaluation; Randomized Controlled Trials as Topic; Screening; Social interactions; Socioeconomic Factors; Chicago; health disparity; diagnostic mammography; breast cancer; barriers; distrust; gendered social norms
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.31636

Background Black women are more likely to be diagnosed at a later stage of breast cancer in part due to barriers to timely screening mammography, resulting in poorer mortality and survival outcomes. Patient navigation that helps to overcome barriers to the early detection of breast cancer is an effective intervention for reducing breast cancer disparity. However, the ability to recognize and seek help to overcome barriers may be affected by gendered and racialized social expectations of women. Methods Data from a randomized controlled trial, the Patient Navigation in Medically Underserved Areas study, were used. The likelihood of obtaining a follow‐up screening mammogram was compared between women who identified ≥1 barriers and those who did not. Results Of the 3754 women who received the Patient Navigation in Medically Underserved Areas navigation intervention, approximately 14% identified ≥ 1 barriers, which led to additional navigator contacts. Consequently, those women who reported barriers were more likely to obtain a subsequent screening mammogram. Black women, women living in poverty, and women with a higher level of distrust were less likely to report barriers. Conclusions Minority women living in poverty have always been the source of social support for others. However, gendered and racialized social expectations may affect the ways in which women seek help for their own health needs. A way to improve the effectiveness of navigation would be to recognize how minority women's gender images and expectations could shape how they seek help and support. A report of no barriers does not always translate into no problems. Proactive approaches to identify potential barriers may be beneficial. Gendered and racialized social expectations may affect the ways in which women seek help for their own health needs. A way to improve the effectiveness of patient navigation would be to recognize how the gender images and expectations of minority women could shape how they seek help and support.