Some women come from cultures that consider it inappropriate for women to touch or look at their own breasts, said Sandra Millon Underwood, PhD, RN, FAAN, a professor at the University of Wisconsin-Milwaukee School of Nursing who researches cancer prevention in relation to minority populations. Fatalistic attitudes play a part, too. Many black women believe that breast cancer inevitably ends in a mastectomy and death, Underwood said, so they re less likely to get screened or examine themselves. In addition, minority women are less likely to be well-educated, so they may be more vulnerable to fear and superstition, say cancer experts. Mont. In general, women with lower educational levels neglect preventive activities such as annual well-woman exams, said Alice F. Judkins, RN, a nurse in breast surgical oncology at the University of Texas M.D. Anderson Cancer Center in Houston.
Poverty also plays a role, and nonwhite women are more likely to be poor.
Getting a mammogram is often the last thing on the mind of a woman who can t even afford health insurance. M.D. Anderson tackles this problem by dispatching screening vans to grocery-store parking lots in an effort to make screening available, affordable, and visible, Judkins said. But the differences in mortality rates aren t entirely attributable to a lack of screening, said Underwood, who noted that regardless of income, the length of time between diagnosis and treatment is far longer for black women than for other groups. Healthcare providers have to consider the possibility that ethnic minorities are not receiving the same quality of care as whites, say cancer experts. Several minority researchers have demonstrated statistically that when you control for socioeconomic level and look at within-group differences, those discrepancies still exist to a statistically significant level.