INTRODUCTION

Breast are major sources of cancer mortality and together account for nearly 18% of the cancer mortality burden in this country. The favorable trends noted in breast and colorectal cancer mortality for white women during the 1990s were not evident for African-American women, many of whom have poor access to healthcare and early detection. Currently, women from lower socioeconomic backgrounds are less likely to undergo routine breast cancer screening when compared with other groups. Low-income populations have the lowest rates of screening for colorectal cancers and present at later stages when affected. The gaps in mortality rates associated with these cancers for African Americans and whites have widened, and warrant attention through approaches emphasizing communication about ways to moderate individual risk.

Royak-Schaler and colleagues (2002) investigated disparities in risk communication and found that African-American women were less likely than whites to report being informed of their increased personal risk due to family history. Both African-American and white, first-degree relatives of breast cancer patients who had discussed family history and level of risk with their providers were significantly more likely to have had a mammogram within the past two years. While these discussions seemed to increase participants’ perceived risk of developing breast cancer, they did not promote knowledge of risk factors or increase levels of cancer concern. In contrast to the excessive concerns, distress, and functional impairment previously reported in the literature for largely white populations, low mean levels of concern about breast cancer were observed for both the white and African-American samples in this study population, 6.1 and 6.6 respectively, on a scale ranging from 4 to 16. It is significant to note that other studies have interpreted scores of 5 to 8 on a similar Breast Cancer Worry Scale (range of 4 to 16) to be indicative of excessive concerns that would interfere with screening compliance. In this study, however, both perceived risk and screening compliance increased with provider conversations about family history and personal risk. canada drugs pharmacy

Another study that examined the relationship between breast cancer worry and mammography screening also found that women who were moderately worried were more likely to participate in annual mammography than those who were mildly or severely worried. Additional studies have also identified the motivating effect that communications emphasizing women’s levels of personal vulnerability to cancer risk factors can have on their screening behavior. These studies suggest that risk communication, which is designed to significantly increase a woman’s level of worry, may be counterproductive for promoting early detection. Instead, communications which moderate a women’s levels of worry appear to be most effective for promoting decisions to participate in screening programs.

Breast and colorectal cancer screening decisions in minority populations have been linked to patient knowledge of risk factors, perceptions of personal risk, and cancer concerns. Even though information on breast cancer risk is widely available to women and the physicians who provide their breast healthcare, many women are unable to identify the major risk factors and continue to mis-perceive their risk of developing breast cancer. The behavioral consequences of over- or underesti mating one’s personal risk of developing either breast or colorectal cancer are not well understood and warrant further investigation.

To address this important issue, the qualitative study described in this report was designed to investigate perceptions of personal cancer risk, understanding of risk factors and risk reduction behavior, and strategies for delivering risk information to low-income African-American and Hispanic women. We incorporated approaches to risk communication developed by the first author of this paper in her North Carolina studies with African-American women (n=569), which identified the important link between women’s reports of provider risk communication and behavior leading to screening compliance. In the present study, we investigated the process of risk understanding and appraisal among urban, low-income African-American and Hispanic women whose significant risk factors for postmenopausal breast and colorectal cancers include obesity, sedentary lifestyle, and poor rates of early detection.