Black Women's Perspectives on Breast Cancer Risk Assessment

Abstract

Purpose: The aim of this study was to gather the perspectives of Black women on breast cancer risk assessment through a series of one-on-one interviews.

Methods: The authors conducted a cross-sectional qualitative study consisting of one-on-one semistructured telephone interviews with Black women in Tennessee between September 2020 and November 2020. Guided by the Health Belief Model, qualitative analysis of interview data was performed in an iterative inductive and deductive approach and resulted in the development of a conceptual framework to depict influences on a woman's decision to engage with breast cancer risk assessment.

Results: A total of 37 interviews were completed, and a framework of influences on a woman's decision to engage in breast cancer risk assessment was developed. Study participants identified several emerging themes regarding women's perspectives on breast cancer risk assessment and potential influences on women's decisions to engage with risk assessment. Much of women's decision context was based on risk appraisal (perceived severity of cancer and susceptibility of cancer), emotions (fear and trust), and perceived risks and benefits of having risk assessment. The decision was further influenced by modifiers such as communication, the risk assessment protocol, access to health care, knowledge, and health status. Perceived challenges to follow-up if identified as high risk also influenced women's decisions to pursue risk assessment.

Conclusions: Black women in this study identified several barriers to engagement with breast cancer risk assessment. Efforts to overcome these barriers and increase the use of breast cancer risk assessment can potentially serve as a catalyst to address existing breast cancer disparities. Continued work is needed to develop patient-centric strategies to overcome identified barriers.

Keywords: Breast cancer; implementation science; mammography; patient perspective; risk assessment.

Figure 1.

Framework for an Individual’s Decision to Engage in Breast Cancer Risk Assessment. This framework describes influencers of a patient’s decision to engage with breast cancer risk assessment including decision context, modifiers such as communication and protocol preferences, and perceived challenges with follow-up care.