Study finds women skip mammograms despite family history of cancer

Dr. Saleh Rahman, an assistant professor of public and allied health in the College of Health and Human Services at BGSU, conducted a study of nearly 30,000 women to determine what factors influenced their behavior in following recommendations about regular mammography. His findings were presented at the American College of Preventive Medicine 2003 meeting in San Diego.

The women in the study, ages 40-90, were entered into the database of the Colorado Mammography Project. The survey looked at such factors as economic status, education, race, insurance and family history, for the period from 1994-98.

Rahman, whose research interests focus on prevention and control of breast cancer, speculates that fear could be a reason for avoidance of mammograms by women with a family history of breast cancer even when all other variables—such as insurance, education and financial security—are taken into account. “

I was surprised. I thought a family history of breast cancer would be a positive influence in whether they got mammograms, since it was considered a ‘cue to action’ in many behavioral studies. But fear can be a very significant factor.”

Though educated white women with higher incomes and insurance coverage were the most likely to have regular mammograms, women in their forties with a family history of breast cancer were less likely to do so. “There’s a denial there,” the BGSU professor said.

“Since we can’t yet prevent cancer, we have to look at morbidity reduction through early diagnosis and secondary prevention, which includes clinical breast exam and mammograms. I feel that if we can understand the factors that influence a woman’s adherence to the recommendations, we may be able to have a positive effect on their decisions.

“Human behavior is a very complex phenomenon,” he points out. “We have to examine all the psychological, cultural, economic and other factors that come into play.”

Rahman proposes using community theater as a grassroots method of reaching women in their own environments. Utilizing information and “cues” provided by public health officials, local performers improvise about situations they may have personally experienced to trigger an emotional response in both the performers and their peer audience. This communication approach, according to Rahman, has been used successfully in Australia, South Africa, Bangladesh and India in AIDS prevention and diabetes education. “Credibility and trustworthiness are good predictors of whether a message will be accepted,” according to Rahman.

Rahman, who also teaches at the Medical College of Ohio as an adjunct assistant professor of medicine, earned his medical degree from Dhaka University in Bangladesh. He holds a master of public health degree from Harvard University’s School of Public Health and a doctorate of public health from the University of Alabama at Birmingham.

Following the initial study, Rahman completed a local research project in conjunction with the director of the MCO Cancer Institute. That survey, conducted in 2001 and 2001, looked at 285 Toledo-area women to assess their perception of mammograms and the risks of cancer. “We wanted to see if there were cultural barriers to women’s adherence to the recommendations for screening,” he said. This fall he plans to begin to conduct a study with Wood County Hospital. He also is in the process of examining another set of data with 10,000 women from the Colorado Surveillance (Mammography Project). These women were diagnosed with breast cancer in 2000 and he will examine whether adherence to mammography guidelines has an impact on the survival and reduction of mortality.”

How often, and at what ages, women should have mammograms has been a subject of debate among the 11 major U.S. organizations that deal with breast cancer research and prevention. Recently they jointly settled on a recommendation that all women over 40 should undergo the procedure done annually.

(Posted August 18, 2003 )