Breast Cancer-Screening Behavior among Rural California American Indian Women

A community-based Wellness Circles Program was designed and implemented at thirteen sites in California. Data obtained from the BRFSS that was administered to a subset of women demonstrate that American Indian women continue to underutilize breast cancer–screening procedures. American Indian breast cancer–screening rates were compared to national and state general populations. On all measures, screening procedures among the study population were found to be below that reported by the state of California and national BRFSS data reports and the Healthy People 2010 objectives.14 Despite the availability of many cancer-screening tests, a significant number of American Indian women do not follow recommended screenings. Barriers to participation are complex and often involve cultural values and beliefs.15 Even when, for example, mammography appointments have been scheduled, many Indian women fail to keep them, and the noncompliance rate among American Indian women is particularly high.16 The concept of “deferred care” may provide an explanatory reason for noncompliant behavior in breast cancer screenings. California American Indian women reported delaying their mammography for five years or more, which can be described as deferred care. Discussion of “putting up with and enduring” is suggested as a possible reason for late screening or noncompliance with recommended screening. This behavior may be a significant cause for reported failure to obtain cancer screening and deserves further attention. Cancer screening is an important behavior that health educators and health care providers seek to reinforce. Many groups, including American Indians, fail to participate sufficiently in prevention screening activities. To improve this situation, the design and implementation of cultural and multi-generational educational materials are recommended. In short, culturally appropriate cancer education is needed to improve screening participation among this special population.17 The need for improved screening rates and the need to address barriers to screening among rural Indian groups are essential if cancer is to be prevented and controlled in these groups. The failure of many ethnic groups to adhere to recommended screening is of concern to health educators and providers. In American Indian populations, culturally appropriate social support interventions may be particularly effective in promoting cancer screening and thus in reducing cancer mortality.18 The sense of “putting up with and enduring”—generated from role expectations and placing oneself as less of a priority—creates barriers that further repress cancer screening. We must address this sense of deferred care directly and seek to alter its logic in future cancer-screening programs. To move from the cultural concept of deferred care to the contemporary concept of “self-responsibility” is a necessary step. The literature on health-seeking behaviors describes the route or pathways to obtaining care through advocates, self-help, or education. This literature, however, does not recognize the concept of deferred care. Doing without and delaying or deferring preventative screening in the belief that family or community members are more important, and that their needs take precedence over one’s own personal health needs, can lead to serious health conditions. Family roles and responsibilities, barriers, or priorities, as determined by cultural and economic conditions, can lead Indian women and men to forgo their health screenings—resulting in the burden of illness.