Is breast cancer fatalism a factor for adherence to mammography screening among American Indian women?

Background: Research on breast cancer fatalism (BCF) among American Indian (AI) women has been limited to qualitative studies. This study examined the association of BCF with past mammography and its association with demographics (i.e. age, educational/income level, and marital status), access to mammography (i.e. private health insurance, primary physician, and annual physician visits), breast cancer family history, mammography screening knowledge and cultural affiliation. Methods: Data were collected from 162 (mean age=50 years) randomly selected AI women residing in rural Oklahoma. BCF was measured with 5 items (Powe Fatalism model, Cronbach Alpha: 0. 74). Strength of cultural affiliation (Mood, 1999) was measured via 16 items (Cronbach Alpha: 0. 87). Spearman correlation coefficient, a 2-sample t-test and ANOVA methods were used with a two-sided alpha of 0.05. Results: 58% (95% CI: 59%-66%) of participants reported a mammogram within the last 2 years. Women with a mammogram within the last 2 years had lower mean fatalistic scores than those without (11.36 vs. 14.78, p<0.0001). Women who were less educated, less affluent, less knowledgeable about mammograms and living alone were more likely to be highly fatalistic (p=0.0004, p=0.007, p=0.0006, p=0.018 respectively). None of the other variables were related to BCF. Conclusion: In the development of related interventions among AI women, BCF could be a factor. As supported by the literature, BCF is positively related to low socioeconomic status (e.g. education, employment, income) and lack of mammography screening knowledge. Surprisingly, BCF was not related to age, access to health care, and cultural affiliation.