How Women Decide to Seek Evaluation of Breast Symptoms

Institution: University of California, San Francisco
Investigator(s): Noreen Facione, Ph.D., R.N., F.N.P. -
Award Cycle: 1995 (Cycle I) Grant #: 1KB-0045 Award: $223,588
Award Type: New Investigator Awards
Research Priorities
Detection, Prognosis and Treatment>Imaging, Biomarkers, and Molecular Pathology: improving detection and diagnosis

Initial Award Abstract (1995)
This project focuses on earlier detection of breast cancer for the women of California by examining women's decision of whether and when to seek an evaluation of a potential breast cancer symptom. Seeking a provider evaluation of a self-discovered breast symptom (often referred to as 'help seeking' in the literature) is an important factor in early case-finding. In the majority of breast cancer cases, and particularly those in women of African American and Latina cultural heritage, the symptoms of breast cancer are discovered by the women themselves. Current breast symptoms, perceptions of the consequences of delay, gender related constraints, access to services, prior utilization habits, fatalistic beliefs about breast cancer, and religiousness explained 46% of the variance in help seeking intention in a sample of 352 African American women in a previous investigation. This study will re-examine these variables and three others (perceptions of racism, breast cancer symptom knowledge and decision-making style) for their predictive power to describe the intention to seek help promptly versus the intention to delay a provider evaluation for a self-discovered breast cancer symptom in a more culturally diverse sample. By identifying the factors that influence a woman's decision to seek or not seek an evaluation of her breast symptoms, this project's long-term goal is to identify women at risk for more advanced breast cancer at diagnosis related to delays in help seeking.

Using multiple methods, this community-based study will take a culture-specific approach to the study of help seeking for breast cancer symptoms in San Francisco Bay area women. Study participants will be stratified to span income, education and age. Targeting community organizations will purposefully recruit Latinas and African American women (over-represented in women with advanced breast cancer at diagnosis). The inclusion of non-Latina white women in the study will allow the examination of the generalizability of factors identified as significant for delaying help seeking across cultures. This investigation will provided valuable information for interventions designed to influence decision-making regarding prompt help seeking for self-discovered breast symptoms that may signal the presence of breast cancer.

Final Report (1999)
Involving more than 1,000 women in the San Francisco Bay area in community based focus groups, surveys, and interviews, this project has described how women make judgments about self-discovered breast symptoms that might signal breast cancer.

The many influences on this judgment process have been described in three diverse groups in California: women who identified themselves as Anglo/White, African American/Black, or Latino/Hispanic. Women were asked to talk in either English or Spanish about their breast symptom history and to report their likelihood of delaying seeking a provider evaluation of breast symptoms. The likelihood of making the judgment to delay was correctly predicted in 31% to 66% of the women in these three cultural groups. The most influential of these variables are characterized by attitudes and beliefs that are common to each of the three cultural groups.

These influences include but are not limited to inaccurate beliefs about the incurability of breast cancer and its presenting symptoms, perceptions of constraints on early detection associated with women's roles, immigration concerns and provider relationship issues. A proportion of this volunteer sample (13.1%) reported currently having breast symptoms and only 50% of these had been examined by a provider. The variables identified as associated with a judgment to delay correctly predicted actual delay behavior in 87% (52 or 60) of these women.

Much has been learned about the actual social and psychological variables that influence women to make the judgment to delay seeking evaluation and diagnosis of their self-discovered breast symptoms. This information can immediately inform early detection programs that are aimed at decreasing the proportion of women who present with advanced breast cancer at diagnosis.

Narratives of breast symptom discovery and cancer diagnosis: Psychologic risk for advanced cancer at diagnosis.
Periodical:Cancer Nursing
Index Medicus: Cancer Nurs
Authors: Facione NC, and Giancarlo CAF
Yr: 1998 Vol: 21 Nbr: 6 Abs: Pg:430-440

Breast cancer screening in relation to access to health services
Periodical:Oncology Nursing Forum
Index Medicus: Oncol Nurs Forum
Authors: Facione NC
Yr: 1999 Vol: 26 Nbr: 4 Abs: Pg:689-96

Equitable access to cancer services in the 21st century.
Periodical:Nursing Outlook
Index Medicus:
Authors: Facione, N.C. and Facione, P.A.
Yr: 1997 Vol: 45 Nbr: 3 Abs: Pg:118-124

Helpseeking for Self-Discovered Breast Symptoms: Implication for cancer early detection.
Periodical:Cancer Practice
Index Medicus:
Authors: Facione, N.C., Dodd, M.J., Holzemer, B., Meleis, A.I.
Yr: 1997 Vol: 5 Nbr: 4 Abs: Pg:220-227

Complementary and alternative medicine practices in women with breast cancer
Periodical:American Journal of Nursing
Index Medicus:
Authors: Swanson, S.A. and Facione, N.C.
Yr: 1998 Vol: Apr. Nbr: Supplement Abs: Pg:34-9

The Influence of social support on breast cancer screening.
Periodical:Oncology Nursing Forum
Index Medicus: Oncol Nurs Forum
Authors: Katapodi, M, Facione, N.C., Dodd M.J., Miaskowski C., and Waters, C.
Yr: 2002 Vol: 29 Nbr: 5 Abs: Pg:845-52

The J-Delay Scale: A measure of the likelihood of patient delay in breast cancer.
Periodical:Research and Theory for Nursing Practice: An International Journal
Index Medicus:
Authors: Facione, N.C.
Yr: 2002 Vol: 16 Nbr: 2 Abs: Pg:103-18

The self-reported likelihood of patient delay in breast cancer: New thoughts for early detection.
Periodical:Preventive Medicine
Index Medicus: Prev Med
Authors: Facione, N.C., Miaskowski, C., Dodd, M.J. and Paul, S.M.
Yr: 2002 Vol: 34 Nbr: 4 Abs: Pg:397-407