News Release

Perceptions of prejudice may hamper breast cancer detection

Peer-Reviewed Publication

University of California - San Francisco

San Francisco, CA -- Perceptions of prejudice may inhibit a woman from seeking recommended health care, according to a new study by University of California, San Francisco researchers.

In a community based sample of American women, UCSF researchers found that the frequency of getting mammograms, PAP smears, and performing breast self-examinations were significantly related to a woman's personal experience with prejudice. The study is the first to examine how perceived prejudice influences a woman's approach to breast cancer screening.

The researchers will present their findings as part of a symposium on women's quality of life on Saturday, January 29, 2000 at the 11th International Congress on Women's Health Issues held in San Francisco. The Congress is sponsored by the University of California, San Francisco's School of Nursing in affiliation with the International Council on Women's Health Issues and other co-sponsoring institutions.

"Experiences interpreted as prejudice, combined with a lack of economic access, appear to lead to alienation from the health care system and recommended prevention behaviors," said Noreen Facione, PhD, RN, UCSF associate professor of oncology nursing in the UCSF School of Nursing and principal investigator of the study. "There may be an increased risk of advanced cancer due to social interactions in health care that are being interpreted as prejudice."

The researchers interviewed 897 women, aged 18 to 99 years old, who self-identified as Anglo, Black, or Latino. Interviews were conducted in either English or Spanish. To get a diversity of cultures and ages, the researchers recruited the study participants from 80 different community settings, such as sororities, beauty parlors, and immigrant services. Participants were not recruited from health care settings.

Participants were asked to agree or disagree to ten statements. Five statements related to a person's belief that prejudice exists in the health care system, at least against some individuals such as older women or women on welfare. Five other statements touched on a woman's personal experiences with prejudice, such as the feeling of being ignored or discriminated against.

"We looked at a woman's perception of prejudice, not documented cases of prejudice," said Facione. "That's an important distinction, although both can lead to uncomfortable relationships between a woman and her doctor or nurse."

Forty-nine percent of the sampled women perceived that the health care system was inherently prejudiced toward certain populations of individuals and 20% percent of the sampled women reported some experience of prejudice directed against themselves in the course of seeking health care. Women who reported prejudicial experiences tended to be black, lesbian, or educated at the graduate-level.

The general perception that prejudice was a factor in health care delivery did not deter women from following mammogram, PAP smear, or breast self-examination screening guidelines, but personal experiences with prejudice did. For example, women who experienced prejudice directed toward themselves were more likely to perform breast self-examinations infrequently, if at all. Lack of money or health insurance also influenced a woman's decision to forgo the proper screening, said Facione.

"The observed relationship between reported experience of prejudice in care delivery and lower adherence rates to screening guidelines demands further study," said Facione. "Our study recruited many women who are disconnected from the promise of early cancer detection, in part due to perceived prejudice from their health care providers. If perceived prejudice negatively influences a woman's health care behavior, providers need to start correcting for it."

The researchers also found that nearly 20 percent of the women in the study reported not getting a PAP smear every one to two years and most failed to perform monthly breast self-examinations, as recommended by national guidelines.

The symposium on women's quality of life will also include research on the perceived quality of life of diabetic Palestinian refugee women in Jordan, the impact of cultural mourning practices on bereaved women in Botswana, Philipino women's perspectives on health and health care, and the impact of intimate relationships on homeless women's health and well-being in the United States.

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NOTE TO MEDIA: Noreen Facione will be available for interviews during the 11th International Congress on Women's Health Issues. Please call Rebecca Sladek Nowlis at (415) 476-2557 to arrange an interview or to attend the Congress.


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