Patient-provider partnership, body knowledge, and long-term practice: BSE beliefs and practices among four ethnic groups in a medically underserved area

BACKGROUND: As mammography has become the gold-standard for breast cancer detection, many clinical practice guidelines no longer recommend women do breast self-examination (BSE).

OBJECTIVE: Our findings describe the BSE practices of patients and discuss implications for providers.

METHODS: In our four-year, multi-method study, cancer knowledge, beliefs and attitudes and utilization scales were completed by 300 patients from four ethnic groups (Latino, Vietnamese, African-American, white) at a community health center in a medically underserved area. In addition, in-depth interviews (total N=18) and focus groups (total N=43) were conducted with participants.

FINDINGS: In focus groups, African American, Vietnamese and Latina women offered interviewers an unprompted demonstration of BSE and reported regular BSE use at particular times of the month. Participants who learned BSE when they were young continue the practice in middle age. When asked, nearly 78% of participants said that their providers told them to do BSE. However, only 28% of women do BSE monthly and 45% perform it only when they “think of it.” Latinas are most likely to perform it monthly and Vietnamese women are most likely to do it as it comes to mind.

DISCUSSION: It appears that BSE is practiced long-term by women cross-culturally. Our focus group findings suggest BSE is experienced as a self-care practice that puts women and their body knowledge at the center of their health care, in partnership with their provider. BSE use appears to be encouraged in primary care settings, yet proper BSE practices may not be reinforced equally across ethnic groups.