Participant Characteristics

A total of 42 women (25 African Americans and 17 Hispanics) participated in the focus group discussions. The mean age of participants was 49 years. Demographic data are shown in Table 1. The income and educational status data revealed disparities between the African-American and Hispanic participants. Overall, African-American women were more educated and reported higher household incomes than the Hispanic women participants. Most of the African-American women (88%, 22/25) reported being born in the United States. Three African-American women (12%, 3/25) reported being born in the Caribbean but had been in the United States for a minimum of 12 years (20 ± 11 years). The majority of the Hispanic women (88%, 15/17) reported being born in the Dominican Republic and reported having been in the United States anywhere from 10 to 35 years (20 ± 8.5 years). Two women (11.8%, 2/17) reported being of Puerto Rican ethnicity. One was born in NY, and the other—born in Puerto Rico—reported having been in the United States for five years.

Table 1. Demographic Data*

Study Participants

Total%/n African-American%/n Hispanic %/n
Marital Status Married/Living Together Single/Divorced/Widowed 41 (17/41) 59 (24/41) 42 (10/24) 58 (14/24) 41 (7/17) 59 (10/17)
Education Status8th Grade or Less

9th Grade-High-School Graduate

Some College-College Graduate


24 (10/42) 33 (14/42) 31 (13/42) 12 (5/42) 8 (2/25) 28 (7/25) 44 (11/25) 20 (5/25) 47 (8/17) 41 (7/17) 12 (2/17) 0(0/17)
Total Annual Household Income<$8,000


65 (24/37) 35 (13/37) 50 (10/20) 50 (10/20) 82 (14/17) 18 (3/17)
Employment Status Working Full-/Part-Time Unemployed 35 (14/40) 65 (26/40) 35 (8/23) 65 (15/23) 35 (6/17) 65 (11/17)
* Sample size differences reflect missing data in some categories.

Focus Group Discussions

Participant Understanding of Cancer Risk Factors

Focus group participants identified genetics, environmental exposures, and the pri­тагу types of factors that place women at higher risk of developing breast cancer. There was limited awareness of risk factors related to reproduction, including age at menstruation, menopause, and first childbirth. Participants in all three African-American groups agreed that genetics predisposed women to breast cancer. However, aging was not associated with the increasing risk of developing breast cancer. It was not considered to be a risk factor because many participants knew of young women with breast cancer.

“I think that at any age, you will get cancer—at any age. So it doesn’t mean that, you know, the older you get you’re likely to get it.” (African-American focus group)

Participants named a wide range of risk factors and causes of breast cancer. There were strong beliefs among these women that smoking and stress increase the risk for breast cancer. Being African-American was also considered a risk factor. Apcalis Oral Jelly

“.. .culturally, I think black women tend to be more stressed out.” (African-American focus group)

“You’re always told that blacks and Hispanics have a higher risk of getting it than, let’s say, Asians or Caucasians.” (African-American focus group)

African-American women identified Asian women as having low risk for breast cancer. One woman attributed this to a calming Eastern religion, high soy and vegetable consumption, use of olive oil, and reduced stress because “men take more responsibility taking care of the family” (African-American focus group).

African-American women acknowledged that high-fat diets, especially those containing a lot of pork and red meat, would increase the risk of getting cancer. Some women explained the link among diet, cancer, and culture.

“Most of us—especially of color—we eat around the same things. We give it to our daughters, our sons, so it’s passed down…It is a risk. I mean, I know a lot of people used to, if they don’t know, used to like pork chops or steak or hamburger, and we was raised on that for generations and generations…” (African-American focus group)

“It’s hard for me to guess how someone my age might get it [breast cancer], but living in this urban thing, I know it’s probably worse than living in the country because they have healthier stuff.” (African-American focus group)

Environmental pollutants and exposures were common risk factors identified and viewed as important causes of breast cancer. Women named truck fumes, bird droppings, neighborhood waste, electric lines, pesticides, food additives, and meat hormones.

Two of the three African-American groups discussed whether bruising or abuse to the breasts could contribute to the development of breast cancer. The Hispanic women had less to say about breast cancer risk factors than their African-American counterparts. They did not name bruising/abuse to the breast or stress as risk factors for developing breast cancer.

Like African-American women, Hispanics in this study believed that breast cancer had little to do with age and was mostly determined by family history. Also consistent with African Americans, Hispanics provided a long list of environmental factors believed to contribute to breast cancer: contaminated foods, pesticides, chemicals, polluted air, radiation, electricity, photography, canned goods, microwaves, and aluminum baking pans because “…the lead they give off goes into the food…” (Hispanic focus group)

Hispanics, like African-American participants, believed that certain meats may increase the risk for breast cancer.

“I understand that there are certain foods, certain meats that are malignant if you eat them like pork. It is a malignant meat, but we, the Hispanics, love pork.” (Hispanic focus group)

Both African Americans and Hispanics were largely unaware of the breast cancer risk factors related to estrogen production and childbearing. They attributed their lack of knowledge in these areas to the absence of discussions about reproductive risk factors with their healthcare providers. When the moderators explained these factors, there was much interest and many questions from the participants. They were interested in learning more about the association of birth-control pills and cancer risk. Like the role of estrogen, birth-control pills appeared to be a new concept for women to consider in relation to cancer risk. There was considerable interest in learning more about menopause and its relationship to cancer. The menopause-related discussions were unrelated to breast or colorectal cancer and so are not summarized in this paper. However, the nature of the discussions demonstrated a clear interest in receiving more information about menopause-related topics by these populations.

Colorectal Cancer Risk. As was true for breast cancer, both populations generally agreed that a family history would predispose them to this disease. Even so, those who acknowledged having family histories of colorectal cancer still felt they were at low or no risk for the disease. Some felt that this was because they were women and that colorectal cancer was more commonly a man’s disease.

Participants had numerous questions about colorectal cancer and its risk factors. They were more interested in obtaining broad-based information about colorectal cancer than in learning about whether they were at personal risk of developing this disease. Women expressed many concerns and questions about hemorrhoids. Many participants associated hemorrhoids with risk factors and/or symptoms of colorectal cancer. They did not know what hemorrhoids were and confused hemorrhoids with cancer itself, hernias, and polyps.

“She had hemorrhoids for years, and the doctor just treated her for hemorrhoids when in reality she had colorectal cancer by that time.” (African-American focus group)

Perceptions of Personal Cancer Risk Breast Cancer. Participants responded to queries about their personal risk of developing breast cancer compared to other women their age, whether anyone had informed them about their level of risk, and whether they were concerned about developing this disease. Overall, the African-American participants did not consider themselves to be at as high a risk as their peers. They did feel that personal risk varied depending on their individual family histories, self-care practices, and the environmental exposures they had during their lives. Hispanic participants also did not believe they were at higher risk of developing breast cancer than were their peers. In this population, perceptions of personal risk were not based on accurate knowledge of risk factors or awareness of any models that are currently in use to assess risk. Participants reported that their physicians had not assessed their risk factors or given them any information about their personal levels of risk.

When queried about screening methods for diagnosing breast cancer, participants believed that mammograms minimized human error and were considered to be the most reliable method for detecting breast cancer. For African-American women, the most common barrier to having mammograms was the expense or lack of insurance. pharmacy uk

Other common barriers were fear of pain, fear of knowing you have breast cancer, and feeling that the other methods of detection were enough.

“So many women believe that it’s hereditary and that if they don’t have it in the family, then what’s the purpose of doing it [getting a mammogram]?” (African-American focus group)

In contrast to their African-American counterparts, no Hispanics in this study population thought that lack of money or insurance constituted a barrier to having mammograms. As a matter of fact, Hispanic women in two different focus groups explained why money was NOT a barrier to having mammograms or receiving medical care.

“There are many programs, whether you have money or don’t have money. Because he who lets himself die here of a disease for lack of money or lack of help, it’s because they didn’t look.” (Hispanic focus group)

Colorectal Cancer. Participants were asked about their personal risk of developing colorectal cancer compared to other women their age, whether anyone had informed them about their level of risk, and whether they were concerned about developing this disease. Both African-American and Hispanic participants clearly had not given much thought to the possibility of developing this disease, perhaps because of their limited knowledge about colorectal cancer. Hispanic participants had not heard much about colorectal cancer and felt that doctors and people in their communities talked more about breast cancer. They were more interested in obtaining accurate information about colorectal cancer than they were in discussing their personal levels of risk. As a result, not much information was elicited from participants about their personal risk projections.
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Participants were asked about their knowledge of and experience with screening methods for diagnosing colorectal cancer. The most common reason participants gave about why women don’t have a sigmoidoscopy or colonoscopy was discomfort or pain. Inconvenience and lack of knowledge about the tests were less-common reasons. One participant felt that because women are not concerned about colon cancer, they do not have the tests. Other women discussed barriers related to the private nature of colorectal procedures and invasiveness of having a colonoscopy.

“My experience was I hit more of a psychological barrier…The idea of such an invasion and in such a way, you know, it’s your rectum as opposed to your breast being examined…” (African-American focus group)