Helpseeking for self-discovered breast symptoms. Implications for early detection.
ABSTRACT Most breast cancer symptoms are discovered by women themselves, and at least one third of these women will be aware of their symptoms for 3 months or more before seeking an initial provider evaluation. The authors identify personal, social, and environmental influences on women's intention to seek an immediate provider evaluation (helpseek) versus to delay evaluation of a breast symptom that worried them.
Black women (N = 352) from the San Francisco Bay are women's organizations, community settings, and churches formed this convenience sample. Participants ranged across age, income, and educational levels. The survey contained 10 scales that measured health behavior variables, including new and existing scales augmented by items derived from prior interview and focus group investigations.
Women of younger age and lower income were significantly less likely to intend to seek an evaluation for self-discovered breast symptoms. Single and partnered women were less likely to seek a provider evaluation than married or widowed women. Perceiving negative consequences of delaying, having previous habits of healthcare utilization, perceiving access to services, and feeling fearful were positively related to the intention to seek evaluation of breast symptoms. Holding fatalistic beliefs about getting breast cancer or dying and perceiving constraints to seeing a provider negatively influenced helpseeking intention. Racism in the healthcare delivery system was perceived, but was not a significant influence on helpseeking intention. A multiple linear regression model containing these variables explained 46% of the variance in helpseeking intention.
This study shows that the intent to helpseek is not merely a matter of education and economics, but is dependent on a complex picture of personal, social, and economic factors. Gynecologic and primary care providers should consider this and the potential influences on helpseeking in the women for whom they provide cancer screening and early detection services. History taking should be expanded to assess women's ideas about the consequences of delaying evaluation of self-discovered breast symptoms, their sense of vulnerability to breast cancer, the constraints on cancer early detection they may be feeling related to role obligations, their economic or strategic limitations to accessing services, the pressures they may feel to hide a breast cancer symptom, or their own tendency to interpret the breast symptom as not threatening. Healthcare providers should not assume that helpseeking for breast symptoms is an automatic behavior for all women. Rather, providers should assess whether a women is the one in three who will delay the evaluation of a breast cancer symptom she discovers herself for months or years.
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ABSTRACT: Despite the increased availability of breast screening services, the majority of breast cancer symptoms are self-discovered. Further, estimates suggest more than a third of women who self-discover breast changes delay seeking a medical evaluation for at least three months, and delays such as these have been associated with reduced chances of long-term survival. This paper presents the results of individual in-depth interviews with women who had sought a medical evaluation for self-discovered breast changes. Results suggested that women follow a staged process that moves from symptom appraisal and attribution, to the consideration of possible consequences of seeking an evaluation, to the decision about whether or not to seek a medical evaluation. Suggestions are made regarding how the study's findings might be used by practitioners seeking to reduce delays in seeking evaluations, and for future research.
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ABSTRACT: When immigrants settle in an adoptive land , they experience socioeconomic transformation that directly impacts their health , often in a negative manner. It is the responsibility of public health and medical authorities to evaluate and attempt to offset these detrimental effects on the health of the community. This has been one of the missions of ACCESS since its inception in 1976. This undertaking by ACCESS has been complicated by the fact that Arabs in the United States are not considered a minority. It is not possible through systematic analysis of data collected by federal and state agencies to understand the health status and health needs of Arab communities in the United States. Despite this limitation , ACCESS has been striving to fill this gap in knowledge through the stimulation of research , the documentation of outcomes , and the facilitation of collaboration and dialogue among scientists interested in the health of Arab communities. ACCESS ' approach has been implemented via close coordination of the activities of three distinct entities : ACCESS Community Health and Research Center , the International Conference on Health Issues in Arab Communities , and ACCESS Health Journal. Each of these entities has contributed individually to the understanding of the status and health needs of Arab communities. Each of these entities has also complemented the efforts of the other two. The outcome has been a steady improvement in our understanding of existing health conditions and health needs in Arab communities , promotion of thriving research directed at improving health within Arab communities , and collaborative efforts to link clinicians and scientists involved in the health of immigrant communities with their counterparts throughout the Arab world. At the ACCESS Community Health and Research Center , innovative research and clinical programs have been administered in Southeast Michigan in two clinical centers operated by ACCESS in Dearborn and Sterling Heights , Michigan. The clinical services have been instrumental in providing badly6th International Conference on Health Issues in Arab Communities; 10/2012
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ABSTRACT: To explore barriers to early presentation and diagnosis with breast cancer among black women. Systematic review. We searched multiple bibliographic databases (January 1991-February 2013) for primary research, published in English, conducted in developed countries and investigating barriers to early presentation and diagnosis with symptomatic breast cancer among black women (≥18 years). Studies were excluded if they did not report separate findings by ethnic group or gender, only reported differences in time to presentation/diagnosis, or reported on interventions and barriers to cancer screening. We followed Cochrane and PRISMA guidance to identify relevant research. Findings were integrated through thematic synthesis. Designs of quantitative studies made meta-analysis impossible. We identified 18 studies (6183 participants). Delay was multifactorial, individual and complex. Factors contributing to delay included: poor symptom and risk factor knowledge; fear of detecting breast abnormality; fear of cancer treatments; fear of partner abandonment; embarrassment disclosing symptoms to healthcare professionals; taboo and stigmatism. Presentation appears quicker following disclosure. Influence of fatalism and religiosity on delay is unclear from evidence in these studies. We compared older studies (≥10 years) with newer ones (<10 years) to determine changes over time. In older studies, delaying factors included: inaccessibility of healthcare services; competing priorities and concerns about partner abandonment. Partner abandonment was studied in older studies but not in newer ones. Comparisons of healthy women and cancer populations revealed differences between how people perceive they would behave, and actually behave, on finding breast abnormality. Strategies to improve early presentation and diagnosis with breast cancer among black women need to address symptom recognition and interpretation of risk, as well as fears of the consequences of cancer. The review is limited by the paucity of studies conducted outside the USA and limited detail reported by published studies preventing comparison between ethnic groups.BMJ Open 01/2014; 4(2):e004076. DOI:10.1136/bmjopen-2013-004076 · 2.06 Impact Factor