STUDY IDENTIFIES BARRIERS TO BREAST CANCER
CARE AMONG HISPANIC WOMEN
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CARE AMONG HISPANIC WOMEN. Anyone that contributes is a welcome addition to StartingAMedicalPractice.com!CHICAGO, IL (ContentDesk) October 20 2003--Although the rate of breast cancer among Hispanic women in the United States is lower than among Caucasians or African Americans, breast cancer is the leading cause of cancer death in this patient population. This result is largely because Hispanic women often are diagnosed after breast cancer has advanced locally or has metastasized to the bone, according to Amelie Ramirez, Dr.PH, associate director for community research, San Antonio Cancer Institute and associate professor of medicine, Baylor College of Medicine. Contributing to the increased mortality is lack of compliance with breast care, Dr. Ramirez explained at the 2003 Clinical Congress of the American College of Surgeons. According to a survey commissioned by the Susan G.
Komen Breast Cancer Foundation, most Caucasians and a sizable proportion of African-American women undergo regular mammographic screening, but only 38 percent of Hispanic women over the age of 40 have yearly breast examinations, Dr. Ramirez observed. Even after they are diagnosed with the disease, Hispanic women tend to skip followup breast care appointments. Surgeons who treat women with breast cancer at the University of Texas Health Science Center may never see a Hispanic woman who has been referred for treatment after an abnormal mammogram, or they may see these women once or not for several months at a time, according to Alexander Miller, MD, director of surgical oncology and of the Cancer Prevention and Risk Assessment Clinic at the Cancer Treatment and Research Center, San Antonio, TX.To begin to understand what keeps Hispanic women from participating in breast care, Drs. Miller and Ramirez conducted a pilot study focusing on the barriers to compliance with treatment recommendations.
The study, which surveyed 117 Hispanic women with breast cancer and 78 of their family members, showed that fear was a principal factor. Ninety-one percent of women and 91 percent of their families reported that patients were afraid of the recommendations that surgeons would make for treatment. Lack of health insurance was another critical element. Seventy-five percent of women and 80 percent of families said the high cost of health care was a major reason why patients did not follow breast cancer care recommendations. "Hispanic women may have to choose between coming in for breast cancer care follow-up or putting food on the table," Dr.
Ramirez asserted. "Hispanic women also tend to put themselves a little lower on the totem pole in terms of family needs," she added. So rather than devote scarce household resources for their own health care, "Hispanic women tend to procrastinate or avoid coming in for a followup visit," she said.Other reasons for not complying with breast cancer care identified in the study were the inability to understand the physician (reported by 81 percent of women and 77 percent of their families), a previous bad experience with a physician (reported by 79 percent of women and 78 percent of families), and inability to take off time from work (reported by 75 percent of women and 58 percent of families).The findings from this study are leading Drs. Miller and Ramirez to explore ways of eliminating obstacles to breast cancer treatment among Hispanic women. One is by increasing awareness among physicians and surgeons about women's fears.
"Physicians need to understand that these patients come in with a lot of trepidation, so they need to take extra time to explain the risks of the disease and of not seeking treatment, and help these women in making decisions about available treatment options," Dr. Ramirez said.Also important for physicians to understand is the importance of involving family mem-bers in treatment discussions. Dr. Ramirez pointed out that Hispanic women bond closely with their families and therefore may welcome having family members involved in discussions about treatment options. "We recognize that the health care system can be very intimidating.
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