Examining effects of informational, interpersonal and structural barriers on use of mammography in African American communities

Racial disparities in breast cancer mortality are, in part, due to differences in screening and early detection. This study examined how informational, interpersonal and structural barriers to mammography were associated with multiple screening behaviors. Data were obtained from the Reflections of You project, which placed computerized breast cancer education kiosks in 91 settings within African American communities between 2003-2007. The touch-screen kiosks collected information from more than 10,000 individuals, and used their answers to create and print each person a tailored mammography magazine. We analyzed data from kiosk users aged 40 and over (n=2,607) using multinomial logistic regression. We compared the influence of breast cancer and mammography knowledge and self-reported barriers across three breast cancer screening categories: never been screened (NBS), last screened more than a year ago (not current), and screened within the past year (current). The study found not receiving a provider recommendation, lack of awareness of local screening facilities, and inaccessible hours of operation of screening facilities to be significant predictors of being in the NBS and not current groups after adjusting for age and insurance status. Additionally, unique predictors of being in the NBS group included lack of transportation to screening facilities, not having a friend or relative who has had a mammogram, and belief in three distinct myths about breast cancer and mammography. Given disparities in late stage breast cancer diagnosis, these findings can aid in developing targeted education and outreach strategies for cancer prevention and control, especially those targeting never-been-screened populations.