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J Natl Med Assoc. 2000 March; 92(3): 136–142.
PMCID: PMC2640558

Using cultural beliefs and patterns to improve mammography utilization among African-American women: the Witness Project.


Breast cancer and early detection of the disease is a significant issue for all women. Moreover, the sociocultural implications in the differential mortality rates increased interest in possible barriers to screening practices. Recently, a number of studies have investigated African Americans' cultural beliefs associated with breast cancer. This study is based upon qualitative focus group data gathered from 1989 to 1991 and 1996. This article provides focus group data that informed a culturally competent community-based cancer education program for African-American women--the Witness Project. Analysis of the qualitative data along with the quantitative outcome data revealed a direct relationship between cultural beliefs and patterns with mammography utilization. The once perceived cultural barriers can actually be applied as a cultural intervention strategy to improve breast cancer screening initiatives designed specifically for African-American women.

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Selected References

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  • Bailey EJ. Sociocultural factors and health care-seeking behavior among black Americans. J Natl Med Assoc. 1987 Apr;79(4):389–392. [PMC free article] [PubMed]
  • Erwin DO, Spatz TS, Stotts RC, Hollenberg JA, Deloney LA. Increasing mammography and breast self-examination in African American women using the Witness Project model. J Cancer Educ. 1996 Winter;11(4):210–215. [PubMed]
  • Chu KC, Tarone RE, Kessler LG, Ries LA, Hankey BF, Miller BA, Edwards BK. Recent trends in U.S. breast cancer incidence, survival, and mortality rates. J Natl Cancer Inst. 1996 Nov 6;88(21):1571–1579. [PubMed]
  • Chu KC, Baker SG, Tarone RE. A method for identifying abrupt changes in U.S. cancer mortality trends. Cancer. 1999 Jul 1;86(1):157–169. [PubMed]
  • Eley JW, Hill HA, Chen VW, Austin DF, Wesley MN, Muss HB, Greenberg RS, Coates RJ, Correa P, Redmond CK, et al. Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA. 1994 Sep 28;272(12):947–954. [PubMed]
  • Natarajan N, Nemoto T, Mettlin C, Murphy GP. Race-related differences in breast cancer patients. Results of the 1982 national survey of breast cancer by the American College of Surgeons. Cancer. 1985 Oct 1;56(7):1704–1709. [PubMed]
  • Roach M, 3rd, Alexander M. The prognostic significance of race and survival from breast cancer: a model for assessing the reliability of reported survival differences. J Natl Med Assoc. 1995 Mar;87(3):214–219. [PMC free article] [PubMed]
  • Bain RP, Greenberg RS, Whitaker JP. Racial differences in survival of women with breast cancer. J Chronic Dis. 1986;39(8):631–642. [PubMed]
  • Lannin DR, Mathews HF, Mitchell J, Swanson MS, Swanson FH, Edwards MS. Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA. 1998 Jun 10;279(22):1801–1807. [PubMed]
  • Lauver D. Care-seeking behavior with breast cancer symptoms in Caucasian and African-American women. Res Nurs Health. 1994 Dec;17(6):421–431. [PubMed]
  • Dole GF, Carney PA. Characteristics of underserved women who did and those who did not use a free/low-cost voucher as part of a mammography screening program. J Cancer Educ. 1998 Summer;13(2):102–107. [PubMed]
  • King E, Rimer BK, Benincasa T, Harrop C, Amfoh K, Bonney G, Kornguth P, Demark-Wahnefried W, Strigo T, Engstrom P. Strategies to encourage mammography use among women in senior citizens' housing facilities. J Cancer Educ. 1998 Summer;13(2):108–115. [PubMed]
  • Taylor VM, Thompson B, Montano DE, Mahloch J, Johnson K, Li S. Mammography use among women attending an inner-city clinic. J Cancer Educ. 1998 Summer;13(2):96–101. [PubMed]
  • Stein JA, Fox SA, Murata PJ. The influence of ethnicity, socioeconomic status, and psychological barriers on use of mammography. J Health Soc Behav. 1991 Jun;32(2):101–113. [PubMed]
  • Burack RC, Liang J. The acceptance and completion of mammography by older black women. Am J Public Health. 1989 Jun;79(6):721–726. [PubMed]
  • Costanza ME. Breast cancer screening in older women. Synopsis of a forum. Cancer. 1992 Apr 1;69(7 Suppl):1925–1931. [PubMed]
  • Kang SH, Bloom JR, Romano PS. Cancer screening among African-American women: their use of tests and social support. Am J Public Health. 1994 Jan;84(1):101–103. [PubMed]
  • Gregg J, Curry RH. Explanatory models for cancer among African-American women at two Atlanta neighborhood health centers: the implications for a cancer screening program. Soc Sci Med. 1994 Aug;39(4):519–526. [PubMed]
  • Mathews HF, Lannin DR, Mitchell JP. Coming to terms with advanced breast cancer: black women's narratives from eastern North Carolina. Soc Sci Med. 1994 Mar;38(6):789–800. [PubMed]
  • Loehrer PJ, Sr, Greger HA, Weinberger M, Musick B, Miller M, Nichols C, Bryan J, Higgs D, Brock D. Knowledge and beliefs about cancer in a socioeconomically disadvantaged population. Cancer. 1991 Oct 1;68(7):1665–1671. [PubMed]
  • Erwin DO, Spatz TS, Turturro CL. Development of an African-American role model intervention to increase breast self-examination and mammography. J Cancer Educ. 1992 Winter;7(4):311–319. [PubMed]
  • Caplan LS, Wells BL, Haynes S. Breast cancer screening among older racial/ethnic minorities and whites: barriers to early detection. J Gerontol. 1992 Nov;47(Spec No):101–110. [PubMed]
  • Fletcher SW, Harris RP, Gonzalez JJ, Degnan D, Lannin DR, Strecher VJ, Pilgrim C, Quade D, Earp JA, Clark RL. Increasing mammography utilization: a controlled study. J Natl Cancer Inst. 1993 Jan 20;85(2):112–120. [PubMed]
  • Jones BA, Kasl SV, Curnen MG, Owens PH, Dubrow R. Can mammography screening explain the race difference in stage at diagnosis of breast cancer? Cancer. 1995 Apr 15;75(8):2103–2113. [PubMed]
  • Mandelblatt J, Andrews H, Kerner J, Zauber A, Burnett W. Determinants of late stage diagnosis of breast and cervical cancer: the impact of age, race, social class, and hospital type. Am J Public Health. 1991 May;81(5):646–649. [PubMed]
  • Smith RA, Haynes S. Barriers to screening for breast cancer. Cancer. 1992 Apr 1;69(7 Suppl):1968–1978. [PubMed]

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