Abstract C57: Repeat mammography screening among African American women: Qualitative application of the PEN-3 framework
Authors: Adegboyega Adebola , Brandford Arica , Hatcher Jennifer 
Published: March 2017

Abstract
Backgrounds: African American women have a higher mortality rate from breast cancer than any other ethnic group in the country, with an estimated 30,700 new cases of invasive breast cancer and 6,310 deaths expected to occur in 2016. In part the disparate breast cancer mortality rate suffered by African American women can be attributed to irregular mammography screening patterns, which contribute to later stages of diagnosis as compared with other racial ethnic groups. Regular mammography screening may significantly reduce breast cancer mortality and narrow this disparity; however, African American women underutilize mammography screening according to goals set by Healthy People 2020. The purpose of this paper is to identify factors influencing regular breast cancer screening among African American women.
Method: In-depth individual interviews were conducted with 39 African-American women, ranging in age from 42 to 79, who visited the ED of a public hospital with non-urgent complaints and those who were seated in the waiting area. Using qualitative analysis we identified Perceptions (individually held knowledge, attitudes, values or beliefs), Enablers (societal, systematic or structural influences) and Nurturers (supportive or discouraging influences from significant others) that influenced screening decisions. The sample included women who had been screened in the past two years and those who had not. Using the PEN-3 as a theoretical guide we explored, from the perception of the women, the factors that influence screening behaviors.
Findings: The themes that emerged were placed within the appropriate cells (perceptions, enablers or nurturers) in the PEN-3 framework. The findings indicated that women's perceptions included fear of pain associated with mammography, fear of results, and fear of the unknown, fatalistic beliefs, and limited knowledge of personal risk for breast cancer. The only difference between the perceptions of women who had screened in the past two years and never screened women was knowledge. Women who had been screened in the past two years had more knowledge of mammography procedure and endorsed perceptions such as screening provides reassurance and maintenance of good health.
Enablers identified included cost, access, gender and attitudes of the mammography provider, socioeconomic and race related discrimination, and previous experiences within the healthcare system. Previously screened women were more likely to have a source of insurance but both screened and unscreened women discussed financial burden associated with screening. Participants in both screened and unscreened groups emphasized the fact that their previous experiences within the healthcare influenced screening decisions.
Nurturers identified included observations of family member's experiences with cancer, lack of health-related social support and shared mammography experiences within participants' social network. Women who receive encouraging feedback about mammography from their social network are more likely to have been screened.
Conclusion: African American women suffer a significant disparity of breast cancer mortality as compared to other women in the U.S. Despite improvements in access, related to the enactment of the Affordable Care Act, this disparity persists. This study explores the influences on the decisions related to regular mammography screening from the perspective of African American women. The findings from this study underscore the critical need for development of culturally tailored interventions that address the issues salient to this population as well as interventions that leverage the powerful social networks that influence health care decisions in this population.
Citation Format: Adebola Adegboyega, Arica Brandford, Jennifer Hatcher. Repeat mammography screening among African American women: Qualitative application of the PEN-3 framework. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C57.