Research has shown that older African-American women are significantly more likely than other demographic groups to die of breast cancer and several have connected this fact to issues of culture and religion, not to a higher biological propensity.
The question this article poses then, is will an education-based intervention aimed at encouraging routine mammograms among older African American women with firm beliefs about the role of religion in curing breast cancer reduce the rates of breast cancer in this group if the education and awareness-raising is done in a manner that is sensitive to concerns of individual faith?
As the response to this question will elaborate upon, it is clear that there are specific demographic population groups that exhibit higher mortality rates as a result of breast cancer, in part because of later detection and/or an unwillingness or lack of urgency to have the presence of a self-identified lump examined in a medical context. The group that is the focus for this research question has been shown to delay screening, even with the presence of a palpable lump, for reasons that are religious in nature. With more generalized research on breast cancer screening based on extensive review of the literature over the course of several years as the backbone, the education-based intervention will have to simultaneously address personal concerns of faith and medicine in order to influence and make this identified group of women aware of medical options.
In 2002, a study (Mitchell et al) was conducted in response to the higher mortality rates from breast cancer for African American women, which were partly due to late-stage diagnosis. This study of over 650 women of mixed ethnic backgrounds but all over the age of 40 specifically addressed the influence of religious beliefs and how they had an effect on a woman’s perception of the cancer treatment and the future of the disease. Although a majority of the women responded that once a lump was found, screening and mammography was sought out, a slight majority responded with a religious rather than medical solution, leaving the disease to their religious beliefs as opposed to screening and treatment action. The most prevalent group to express this response was older (than the minimum age of 40) and was made up of lesser-educated African American women of a relatively lower socioeconomic status and the study explored these facts through the survey, which was conducted in the homes of the respondents in two counties in eastern North Carolina.
Of particular interest in terms of the research question being posed are a few critical facts. First, as suggested by the study, “although religious beliefs about breast cancer are generally widely held in this population [southern United States, over 40 years of age], fewer women agree that religious beliefs take the place of medical treatment" (Mitchell et al. 2002). With this in mind, the research supporting that the much smaller portion of respondents, nearly all of whom were older than the median age, African-American,women of a lower educational and socioeconomic status demonstrated that religious belief “had a positive effect on women’s intention to delay presentation of a self-discovered breast lump" (Mitchell 2002) because religious faith trumped the importance of screening and possible treatment.
The significance of this is that the intervention, which the research question suggests, should be primarily educational and aimed at informing women in this group about the benefits of early treatment and screening, is that the specific religious issues must be addressed within the context of both respectful religious terms as well as medical terms. In short, by addressing the matter of the important medical benefits of not delaying the lump and obtaining regular mammograms and being sensitive in the approach by not making the medical element sound more legitimate or otherwise “better" than the alternative, these women can become breast cancer survivors and women in this group can experience lower mortality rates as a result of delaying or foregoing regular screening procedures.
In their article published in the Cochrane Database of Systematic Reviews, “Screening for Breast Cancer with Mammography" authors Gotzsche and Nielsen (2008) conclude that “screening likely reduces breast cancer mortality. Based on all trials, the reduction is 20%, but as the effect is lower in the highest quality trials, a more reasonable estimate is a 15% relative risk reduction." While the authors of this compendium study do suggest that there can be issues related to screening such as over-diagnosis and consequent over-treatment, for the purposes of the research question, it is worth mentioning that there is a positive correlation between screening action and lower mortality rates. With this in mind, however, the authors conclude that “the chance that a woman will benefit from attending screening is very small, and considerably smaller than the risk that she will experience harm. It is thus not clear whether screening does more good than harm" and they offer the suggestion that women, their care providers and policy makers should work with one another to determine how screening should occur and how frequently.
While this may be true for a large subset of women, the group in question in this case are women who do not go to screenings and even with the detectable presence of a lump following a self-exam, do not seek treatment right away, instead relying on religious beliefs over medical intervention. Due to the ambiguity of the response of Gotzsche and Nielsen in their extensive review of the literature available on the relationship between screening and reduced mortality rates, it appears that although those not within the group singled out for this research question might not benefit significantly or in large numbers but for these African-American women, knowing the available screening options might aid in getting them in for a visit to identify the lump rather than relying on religion alone.
What must occur then is that this particular demographic of African-American women should be specifically addressed by their regular doctors or community health advocates about what to do if they find a lump, making sure that it is sensitively stated that they are doing the right thing by taking care of their health. This can also be an issue that is addressed by church and religious leaders and women’s groups within faith communities so this group of women can feel that there is a balance between their health and their faith. Based on the conclusions of both works discussed, it is clear that first of all, there is an identifiable group of women who fall in a highly targeted socioeconomic, ethnic, and age group and by nature of this demographic subset of women, targeting specific programs aimed at educating these women while integrating the important ideas of faith and health simultaneously.
One can suggest that the most viable opportunity to address these issues is through community and faith-based organizations therefore the educational approach is not simply medical and the suggestions offered can be evaluated holistically, rather than seeming to only be medical in nature. With this hypothetical approach and in the context stated, the slightly lower rates of mortality that are visible across populations might be higher since this is a group with pre-existing higher mortality rates, in part because of the lack of co-existence between religion and faith and medical intervention.
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Sources
Gotzsche, PC & Nielsen M. (2008) Screening for breast cancer with mammography. The Cochrane Database of Systematic Reviews. Vol 2: The Cochrane Collaboration.
Mitchell et al. (2002). Religious Beliefs and Breast Cancer Screening. Journal of Women’s Health , 907-939.
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