“The money is in the comeback not the cure”: African American views about breast cancer and its treatment

BACKGROUND: Though breast cancer mortality has declined over the past 15 years, the risk of African American women dying from the disease is 37% higher than that of white women in the United States. In Chicago, the risk is estimated to be 49%. Common explanations for this phenomenon include stage of cancer at diagnosis, access to care, and quality of care. It has been suggested that a historically-rooted mistrust in the health care system may underlie these explanations and contribute to such health disparities.

OBJECTIVES: A community-based participatory research focus group approach was used to elicit attitudes, beliefs, and concerns about breast cancer and its treatment from African Americans community members.

METHODS: 503 participants were recruited from 15 of Chicago's predominantly African American neighborhoods on the South Side. Focus group sessions were audiotaped, transcribed, coded using Nvivo Software, and analyzed using Grounded Theory.

RESULTS: Several themes emerged from the focus groups which may contribute to the higher breast cancer mortality rate for African American women: mistrust of the health care system; the financial impact of cancer care and complications with health insurance; concern about exposure to environmental toxins; feeling discouraged from mammography and screening procedures; community reluctance to speak about cancer; and other life concerns considered more salient than health care.

CONCLUSIONS: Emerging themes indicate the manifestation of institutionalized, personally-mediated, and internalized racism within attitudes, beliefs, and concerns about breast cancer and its treatment. Findings suggest policy and practice strategies to reduce breast cancer mortality in African American communities.