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Barriers to screening mean later mammograms for minority women

Black women are more likely to be diagnosed at later stages of breast cancer, not only because of barriers to screening, but perceptions on overcoming those obstacles, according to a study.

Researchers found that programs providing guidance to patients to help overcome barriers to care must consider minority women's views on gender, race and ethnicity. The findings, published Monday in the journal CANCER, reflect how they seek help and support for their health needs.

"Our findings suggest that black women and women living in poverty, who need patient navigation interventions the most, are in fact less likely to report their barriers to optimal care," Dr. Sage Kim, a researcher at the University of Illinois at Chicago's School of Public Health and UI's Cancer Center, said in a press release. "Perhaps women who do not trust the health care system may not feel comfortable telling care providers about their barriers that could potentially affect the ways in which they engage in healthcare."

The rate of new breast cancers was about the same for white women, at 125.6 per 100,000, compared with black women at 123.3 per 100,000, according to the Centers for Disease Control and Prevention. But the rate of cancer deaths was higher among black women, at 27.6 per 100,000, as compared to white women, 19.8 per 10,0000.

One barrier is insurability. A 2017 study found black women were more likely to be uninsured or have Medicaid coverage than white women -- 23 percent versus 8 percent.

For the new study, Kim and her colleagues examined the rates at which women reported barriers to obtaining a screening mammogram. Half the patients were assigned to receive a patient navigation support intervention and others served as a control and did not receive help.

Among the 3,754 women in the patient navigation intervention group, 14 percent identified one or more barriers, which led to additional interactions with navigators who helped overcome barriers.

Black women, women living in poverty and women who reported high levels of distrust of the health care system were the least likely to report barriers. Women who reported barriers were more likely to have additional contact with navigators and obtain a subsequent screening mammogram.

The researchers believe the ability to recognize barriers may determine women's likelihood of reporting barriers and receiving additional support. But medical trust based on past and current experiences of blacks, as well as overall images of women, can affect the likelihood of these women requesting additional help.

Kim said it is essential to understand how minority women and women in difficult life circumstances interact with this intervention. "If we don't, providers may have a false sense of security," she said. "They might incorrectly assume that women who do not report barriers are not in need of patient navigator support and are all doing well."

Outcomes can be improved with training of patient navigators and better attention to how patient navigator interventions are implemented, the researchers said.

"It is not enough to implement a well-tested intervention, because it might not be equally effective for all groups across race/ethnicity and economic conditions," she said.

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