Knowledge of Preventive Breast Cancer
Screening in Low-income Women
According to the National
Breast Cancer Foundation(NBCF), breast cancer is the most common cancer in
women, the second leading cause of death in women around the world and one in
eight women will be diagnosed with cancer in their life time, (2012). Breast
cancer deaths are, however, preventable when detected early and treated.
Although, death from breast cancer has been declining since the 1990s due to
increased awareness, screening, early detection and improved treatment, it has
not been the case for low income women, (NBCF, 2012). My focus is on mammography
as the most effective preventive cancer screening tool, since, “Regular mammography is the
best tool available to detect breast cancer in its earliest stages, availing
opportunities for effective life-saving treatment,” (American Cancer
Society, 2011). Studies have shown that there exists an inaccurate knowledge of
breast cancer screening among low income women around the world which leads to
low screening and consequently high breast cancer death among low income women
in the world.
A study done in Kenya
showed that rural and urban low-income women said that they saw no reason to
have one’s breasts checked if they looked healthy and not painful. And while
most of the urban middle-income women were able to describe early detection
measures such as self-breast exam, clinical breast exam, mammography in detail
and even had experienced them, most urban low-income and rural women had heard
vague knowledge that about breast cancer screening, (Muthoni & Miller,
2009). Another study conducted among low income Hispanics, native Americans and
Caucasians in Wyoming showed that they had a poor knowledge regarding breast
cancer screening and believed that
the absence of a family history of breast cancer implied a low risk for breast
cancer, therefore, no need to get a mammogram. Some of the women thought that
an “Inverted nipple” would be a sign for one to get a mammogram done, (Purtzer, 2012).
A hospital based cross
sectional study was conducted in Ibadan, Nigeria on the level of awareness of
mammography among 818 randomly selected women attending the General outpatient
clinic of the University College Hospital. Only 5% of the women had heard of
mammography and their knowledge of the procedure was poor. The women with no
college education were far less likely to be aware of mammography compared with
those college educated ones. The most common source of information regarding
mammography screening were newspapers and magazines, (Obajimi et al, 2013).
Inadequate health literacy
as a result of low level of education is strongly associated with lower
mammography screening as suggested by a study among Mexican American women in
Texas. Out of a sample of 722 women age 40 and above, only 44% had a mammogram
within the last one year. Participants in the survey were also given the Short
Test of Functional Health Literacy (STOFHLA) in either English or Spanish.
STOFHLA consisted of patient medical instructions for X-ray preparation and the
rights/responsibilities part of a Medicaid application form. Out of 36 questions,
50.42% scored below 22. This implied they had inadequate health literacy, and
consequently a lower mammography screening was demonstrated among the Hispanic
women residing in the Lower Rio Grande Valley of Texas, (Pegan et al, 2012).
Identify three factors that may affect achievement
of optimal health in the selected population.
status, inadequate health literacy related to low level of education, and old
age were associated with poor knowledge of mammography screening in low income
women. The studies examined supported that the above factors are interrelated
in contributing to the poor knowledge and use of mammography screening among
low income women. Breast cancer
screening knowledge and practices among women in southeast of Iran study showed
that overall knowledge of breast cancer screening was inadequate in 67.4% and
only 1.3% had a mammography throughout their life. Furthermore, about mammography, 72.7% had
poor knowledge, 24% had average knowledge and 3.4% had good knowledge. A
questionnaire was used that had demographic characteristics such as age,
educational level, socioeconomic status and knowledge of mammography.
Statistically, there was a significant relationship between the overall
knowledge of breast cancer screening and level of education. The lower the
level of education and socio-economic status, the lower the knowledge of breast
cancer screening. Also, statistically there was an inverse relationship between
knowledge of mammography with age. The older the women, the poorer the knowledge
of mammography. In older women of 40-49years of age, 94.4% had poor knowledge
while women 15-24, 66% had poor knowledge, (Heidari, Mahmoudzadeh-Sagheb
& Sakhavar, 2008).
Iran study above revealed that there is a relationship between low level of
education and poor knowledge on mammography screening in low income women. It is
imperative to say that low income women with low level education have poor
knowledge of mammography screening for breast cancer leading to the higher rate
of death from breast cancer among them.
Implications for practice
income women with either high school or no high school diploma have poor
knowledge of breast cancer screening and, therefore, need to be educated on
preventive breast cancer screening using mammography. Healthcare providers
should not only recommend mammography screening for low income women but teach
them that preventive breast cancer screening is important at age 40 and above,
whether or not risk factors and symptoms are present, in order to detect breast
cancer in its earliest stages. Nurses need to advocate for uneducated low-income
women by making sure that their providers follow up with them regarding preventive
breast cancer screening.
Primary care nurses need to
teach low income patients with only high school diploma or lower level of
education that at age 40 and above, women need to get mammogram screening for
breast cancer every 2 years. Community health nurses practicing in low income
neighborhoods need to educate community members and encourage them to get
mammogram screening every 2 years. Advanced practice nurses need to recognize that
low income women with no college degree are more likely to have a late presentation
of breast cancer, therefore, there is the need to refer them to get a mammogram
whether or not symptoms are present. Also, to provide resources such as breast
cancer clinic locations available for low income families.
an acute care nurse who also works in a Subacute, Rehab and Nursing home
facility, there are always educational resources regarding breast cancer
screening on the company’s educational website that could be handed over to
patients and families. In the near future when I become a primary care provider
at the forefront of health care, I would incorporate into my practice the habit
of teaching and encouraging my patients about breast cancer screening. When I
come across patients in teachable states, regardless of the healthcare setting,
it would be important to recognize these risk factors: Are they low income
women? Is high school their highest level of education? If the answer to my
assessment is yes, then it would be important educate them on the use of mammography
testing for breast cancer after age 40, refer them to breast cancer clinics, follow
up with them to make sure it is done every 2 years.