Breast cancer fatalism and its role in the prediction of past mammography experience among American Indian women in Oklahoma

Background: Literature suggests that breast cancer fatalism (BCF) is an important factor in screening mammography. However, most research on BCF among American Indian (AI) women has been qualitative. This study examined quantitatively the association between BCF, access to mammography screening, breast cancer family history, mammography related knowledge, strength of cultural affiliation, frequency of clinical breast examination (CBE), and cognitions (i.e. attitude, social norms, self-efficacy, perceived susceptibility, social modeling and perceived behavioral control) with past mammography experience over the last 2 years. Methods: Data were collected from 255 (mean age=51 years, SD 7.64) AI women randomly selected from a rural Oklahoma medical clinic. BCF was measured with 5 items (Powe Fatalism model, Cronbach Alpha: 0. 74). Multivariate logistic regression was used to identify factors associated with self-reported past mammography. Results: Of the participants, 65% reported a screening mammogram within the last 2 years. Based on the multivariate model, women with a higher total BCF score by 1 point had a 9% lower odds of having a past mammogram than those with a lower BCF score (OR=0.91, 95% CI: 0.84-0.98, P=0.03). Women who were less likely to be influenced by their physicians, more culturally affiliated, perceived more barriers, had no breast cancer family history and one or no annual CBE had lower odds of past mammography (P<0.01 for each). Conclusion: Fatalism is important to consider in promoting screening mammography adherence among AI women. In addition, other modifiable factors to consider include physician recommendation, addressing barriers to mammography and promoting an annual CBE.