Perceptions of breast health awareness in Black British women

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Abstract

Purpose

Breast cancer is a global concern. Published studies indicate that 43% of Black and ethnic minority women interviewed have reported that they did not practice breast awareness because they did not know the relevant breast changes that occur in breast cancer. Black women are also more likely to receive a diagnosis of breast cancer when it is in an advanced stage. This pilot study aimed to address the views of Black British women on breast health awareness and breast health screening practices.

Methods and sample

In this qualitative study I used semi-structured interviews were used to investigate breast health perceptions, practices and education in a pilot sample of ten women.

Key Results

Women held numerous perceptions of breast cancer which ranged from no knowledge to well informed through receiving extensive education. Two out of ten women were relatively uneducated with regard to breast self examination (BSE). The remaining eight women participated in a variety of screening routines which varied from undertaking BSE everyday to once every few months. Women’s experience of breast health education was also variable. One woman, younger woman, had not received any health education advice in relation to breast health awareness or BSE. The remaining nine women had received some health advice following visit to their General Practitioners, Medical consultant, media information or as a result of participating in mammographic screening.

Conclusions

Black British women require health education that focuses on breast cancer and its associated risk factors, technique of BSE, and national breast cancer screening recommendations.

Introduction

Breast cancer is a global disease and represents not a single disease but a group of tumour subtypes which predominantly affects women (Cancer Research UK, 2010). Women have one in nine chances of developing breast cancer at some time in their lives (Cancer Research UK, 2010). The development of breast cancer is independent of race, ethnicity, religious belief and social status. Breast cancer is not only a multi-ethnic disease but is also the most common form of cancer in ethnic women from first generation immigrants such as Black women (Breast Cancer Research Campaign, 1997).

Although recent data from the US and the UK suggest that Black women have a lower incidence of breast cancer compared to Caucasian women (Grann et al., 2006, Smigal et al., 2006, Jack et al., 2009), the stage of the breast cancer on diagnosis may differ. Li et al., 2003, Grann et al., 2006 and Morris et al. (2007) found that on diagnosis, Black women were more likely to present with an advanced stage of breast cancer. In many cases an aggressive form of disease may be present such as triple-negative breast cancer (Jack et al., 2009). This form of the breast cancer may not respond to chemotherapy and hormonal therapy (Cleator et al., 2007). In contrast, Hahn et al. (2007) reported that Black and Caucasian women presented with a similar stage of breast cancer on diagnosis. Comparisons were made in relation to demographic details, method of detection and breast cancer characteristics. However, Black women differed from Caucasian women with respect to survival characteristics. Reports suggest that Black women have poorer survival data than Caucasian women even when taking in to account the cancer characteristics in terms of stage and size as well as age and demographic details (Li et al., 2003, Grann et al., 2006). In such cases women require earlier detection (Jack et al., 2009).

Although England has a national breast screening programme, the uptake of screening among ethnic minority women is low (DH, 2003), particularly in inner city areas. (Pfeffer, 2004). This may be due to failure to associate mammography with breast cancer (Kernohan, 1996); reduced referrals by physicians (Ansell et al., 1994), reluctance to undertake breast cancer screening (BCS) due to previous negative mammogram screening experience (Thomas, 2004); deficient support from partners and spouses (Facione and Katapodi, 2000) or economic factors that impede travel (Moser et al., 2009). Poor uptake of mammography may also be associated with inadequate knowledge about the aetiology risk factors of breast cancer (White, 1997, Breast Cancer Care, 2005, Scanlon and Wood, 2005). A recent study identified that up to 43% of Black and ethnic minority women had a limited knowledge of breast health awareness and did not know what to look for in terms of breast cancer changes (Scanlon and Wood, 2005). This finding concurs with previous reports (Breast Cancer Care, 2004).

Section snippets

Current state of research

Five studies have examined the experiences of Black women and ethnic minority women in relation to breast self examination (BSE), breast cancer and BCS in England. One study found that investment in breast health awareness at a community level could improve understanding (Kernohan, 1996). In recent studies, black women and ethnic minority women had less knowledge of breast cancer, associated risk factors or participated in BSE compared to Caucasian women which may have been related to deficient

Methods

This exploratory, descriptive qualitative study used qualitative procedures to collect and analyse pilot data using individual semi-structured individual face-to-face interviews with ten women. Interviews were undertaken by the author at a convenient time and location for each participant. The questions used in the interviews were developed from the available literature on breast health awareness and breast cancer in relation to Black women. This literature is predominantly US based, therefore

Sampling procedure

Initially the study was advertised in gyms, relevant churches, mosques and Black ladies hairdressers and Black women’s groups. However these approaches were unsuccessful and failed to generate interest. Snowball sampling was therefore used to recruit a sample of Black British women employed in schools, universities, local industry and health and social care environments. Snowball or networking method is used when target groups are either difficult to reach or where subjects are sensitive (

Framework for analysis

Thematic analysis was used to analyse the interview data (Miles and Huberman, 1994). This is a tried and tested approach that is used to analyse qualitative data and involves “the process of segmentation, categorisation, relinking of aspects of the data base prior to final interpretation” (Gbrich, 2007, p. 16). During thematic analysis, data is reduced to illustrate repeated words, phrases and evidence of answers to research questions. This process involved both file and block (to categorise

Findings

Five themes emerged from the interviews included 1. Awareness of breast health, 2. Breast cancer perceptions, associations and risk factors, 3. Knowledge, impressions and experience of breast cancer screening 4. Education about and frequency of breast self examination 5. Provision of breast health advice.

Discussion

The literature on breast cancer and Black women is predominantly American with a few UK-based studies now emerging (Scanlon and Wood, 2005, Bowen et al., 2008, Waller et al., 2009). Epidemiological evidence suggests that in Black women, the median age for presentation of breast cancer is 46 years compared to 67 years in Caucasian women and Black British women are more likely to present with triple-negative breast cancer. Black women with tumour sized ≤2 cm were associated with enhanced breast

Conclusion

It is recommended that health education interventions be undertaken to target and educate Black women on the principles of breast health awareness. Even with national breast cancer screening campaigns and national breast awareness day, more than half the women in this study remain uneducated about the importance of breast health awareness. The implementation of health education interventions may enhance and promote breast health awareness of the importance of breast cancer in Black British

Conflict of interest

None.

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