Explanatory models for cancer among African-American women at two Atlanta neighborhood health centers: The implications for a cancer screening program

This paper examines cultural models for breast and cervical cancer among low-income African-American women over 40, in order to better understand how those models might affect cancer screening behavior. The study is part of The Community-Based Cancer Screening Project, which is sponsored by Emory University, Grady Memorial Hospital, and the American Cancer Society. The Screening Project attempts to increase the use of mammography, clinical and self-examination of the breast, and cervical Pap smear among women aged 40 or older in a predominantly African-American, low-income, low educational level population that is currently underserved by any screening activities. The study of cultural models of cancer within the project was prompted by the recognition that if screening programs targeted at specific, underserved, populations are to succeed, cultural as well as logistical barriers to screening must be overome. Patients and clinicians must each understand how the other perceives cancer, its prevention, and its treatment. Only with this mutual understanding as a foundation, can physicians and their clients cooperate to improve cancer screening rates. Our research results indicate that the cancer models held by the patient population differ significantly from those held by clinicians. Women attending the clinics endure cancer screening tests that to them seem to serve only as heralds of a disease that will ultimately kill them. Most women doubt there is a cure for cancer, though some believe a person may live if the disease is caught in time. Even then, though, catching cancer 'in time' may mean somehow discovering the disease before it can even be detected as a spot on a mammogram or as dysplastic cells from a pap smear. If the cancer is not caught in time, and a woman is diagnosed as having the disease, some argue that the knowledge that she has it may cause mental deterioration and may speed her death. Even if her mind is unaffected, according to many women interviewed, she still faces treatment choices that may make her poor and seem certain to erode her health even further. Her faith in God seems to be one of the few completely benign and truly powerful treatment alternatives available to her.