Racial Differences in Perception of Breast Cancer Risk in Rural Southeast Georgia

A university-public health collaborative was formed to more fully understand cancer risk among rural women in Georgia. Objectives: This study sought to gain an understanding of racial differences with regard to behavioral risk, perception of breast cancer risk, and perception of barriers to screening. Design: Differences in subjects’ risk and risk perception were assessed by creating, piloting, and administering a written survey at local health departments. Sample: A purposive sample of females enrolled in breast and cervical cancer screening programs in four rural counties in southeast Georgia (n = 147) were surveyed. Subjects were randomly invited to participate. Incentives were provided to enhance participation. Results: White females were significantly more likely than were black females to perceive pollution (OR: 4.63; p = 0.038), smoking (OR: 2.39; p = 0.018), age (OR: 3.01; p = 0.013), and hormone replacement therapy (OR: 3.17; p = 0.005) as factors influencing their breast cancer risk, and to perceive cost as a barrier to screening (OR: 2.89; p = 0.032). From a risk perspective, black females were more likely than white females to have had five-or-more pregnancies (p = 0.005), and to have given birth before age fifteen (p = 0.011). Conclusions: This study provided important baseline data about breast cancer risk necessary in developing effective health promotion programs. jGPHA (2006), Volume 1, Number 2 Corresponding Author: Anthony V. Parrillo, Associate Professor, Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8148, Statesboro, GA 30460-8148, email: aparrill@georgiasouthern.edu This project was funded by the South Central Public Health District, Dublin, GA. The authors gratefully acknowledge the contributions of Brenda Woodard and Fred Young, whose efforts were instrumental in paving the way for this research. Original Research: PERCEPTION OF BREAST CANCER RISK Journal of the Georgia Public Health Association (2006), Volume 1, Number 2 11 Racial Differences in Perception of Breast Cancer Risk in Rural Southeast Georgia Excluding skin cancer, breast cancer is the most commonly diagnosed malignancy among women in the United States (American Cancer Society [ACS], 2005). Breast cancer is the second most deadly form of cancer among women, accounting for approximately fifteen percent of all cancer deaths (Landis, Murray, Bolden, et al., 2000), and has a significant fiscal impact on the nation, with treatment cost estimates in the U.S approximating six billion dollars annually (ACS, 2005). All women are at-risk, and many factors are thought to contribute to their increased likelihood of developing breast cancer. Among the risks that have been linked to increased breast cancer morbidity and mortality are: socioeconomic and cultural factors (Casey, Thiede Call, & Klingner, 2001; Friedman, Webb, Weinberg, et al., 1985; Hughes, Lerman, & Lustbader, 1996; Meade & Calvo, 2001), biologic factors (ACS, 2005; Butler, Potischman, Newman, et al., 2000; Lynch & Lynch, 2002; Gail, Brinton, Byer, et al., 1989; McPherson, Steel, & Dixon, 2000), breast cancer knowledge and behavior (Oliviera & Christos, 1997; Hoffman-Goetz, Apter, Demark-Wahnefried, et al., 1998), and race/ethnicity (Jemal, Murray, Samuels, et al., 2003). In considering race, the data suggest that white women have higher incidence rates of breast cancer than black women, however, mortality rates are disproportionately higher among black women (ACS, 2005; Parker, Davis, Wingo, et al., 1998; Chevarley & White, 1997). In addition, the five-year cancer survival rate is lower among black females as compared to white females (O’Malley, Earp, Hawley, et al., 2001; Blumenthal, 2001). This disparity may be related, in part, to being diagnosed at a much later stage (Eley, Hill, Chen, et al., 1994; McCarty, Burns, Coughlin, et al., 1998; Douglass, Bartolucci, Waterbor, et al., 1995; Hunter, 2000; Makue, Breen, & Fried, 1999). Racial differences in mortality from breast cancer might be attributable to biologically different forms of the disease, as well as disparities in screening behaviors by race. According to several studies, non-white women, in particular black women, are more likely to underutilize available screening services (Douglass et al., 1995; Gornick, Eggers, Reilly, et al., 1996; Foxall, Barron, Houfek, et al., 2001; Calle, Flanders, Thun, et al., 1993; Facione, 1999), resulting in poorer health outcomes. Many factors influence the decision to utilize breast cancer screening services, including one’s perception of risk from breast cancer (Hallal, 1982; Holtzman & Celentano, 1983; Rutledge, 1987; Hopwood, 2000; Paul, Barratt, Redman, et al., 1999; Farley & Flanery, 1989; Caplin, Wells, Haynes, et al., 1992). In addition, individual perceptions may be shaped by a number of factors associated with the lack of culturally competent education about the frequency of breast cancer and the benefits of early detection (Erwin, Spatz, Stotts, et al., 1999; Egbert & Parrott, 2001). A woman’s vicarious experiences with family and friends, along with her spiritual beliefs, are also thought to influence the perception of breast cancer risk. Reducing mortality rates and increasing testing, screening, and the proportion of cancer survivors living fiveor-more years after diagnosis are among the goals of Rural Healthy People 2010 (Gamm, Hutchison, Dabney, & Dorsey, 2003). Regardless, little population-based research is available in Georgia vis-à-vis rural females’ perceptions of breast cancer risk, what perceived barriers may exist related to obtaining screening, or about rural females’ health status. Moreover, there exist in the literature few Original Research: PERCEPTION OF BREAST CANCER RISK Journal of the Georgia Public Health Association (2006), Volume 1, Number 2 12 studies that illustrate how these factors may differ by race. The purpose of this study was to determine the point prevalence of perceptual and behavioral factors related to breast cancer risk in a purposive sample of women enrolled in breast cancer screening programs in four rural counties in southeast Georgia. Specifically, this study sought to understand the factors that influence rural women’s perceptions of breast cancer risk, their perceptions of barriers to screening, and racial differences that may exist with regard to lifestyle and behavior.