Perceptions of prejudice may hamper breast cancer detection

By Rebecca Sladek Nowlis

Perceptions of prejudice may inhibit a woman from seeking recommended health
care, according to a new study by University of California, San Francisco

In a community based sample of American women, UCSF researchers found that the
frequency of getting mammograms, PAP smears, and performing breast
self-examinations were significantly related to a woman’s personal experience
with prejudice.  The study is the first to examine how perceived prejudice
influences a woman’s approach to breast cancer screening.

The researchers will present their findings as part of a symposium on women’s
quality of life on Saturday, January 29, 2000 at the 11th International
Congress on Women’s Health Issues held in San Francisco.  The Congress is
sponsored by the University of California, San Francisco’s School of Nursing in
affiliation with the International Council on Women’s Health Issues and other
co-sponsoring institutions.

“Experiences interpreted as prejudice, combined with a lack of economic access,
appear to lead to alienation from the health care system and recommended
prevention behaviors,” said Noreen Facione, PhD, RN, UCSF associate professor
of oncology nursing in the UCSF School of Nursing and principal investigator of
the study.  “There may be an increased risk of advanced cancer due to social
interactions in health care that are being interpreted as prejudice.”

The researchers interviewed 897 women, aged 18 to 99 years old, who
self-identified as Anglo, Black, or Latino.  Interviews were conducted in
either English or Spanish.  To get a diversity of cultures and ages, the
researchers recruited the study participants from 80 different community
settings, such as sororities, beauty parlors, and immigrant services. 
Participants were not recruited from health care settings.

Participants were asked to agree or disagree to ten statements.  Five
statements related to a person’s belief that prejudice exists in the health
care system, at least against some individuals such as older women or women on
welfare.  Five other statements touched on a woman’s personal experiences with
prejudice, such as the feeling of being ignored or discriminated against.

“We looked at a woman’s perception of prejudice, not documented cases of
prejudice,” said Facione.  “That’s an important distinction, although both can
lead to uncomfortable relationships between a woman and her doctor or nurse.”

Forty-nine percent of the sampled women perceived that the health care system
was inherently prejudiced toward certain populations of individuals and 20%
percent of the sampled women reported some experience of prejudice directed
against themselves in the course of seeking health care.  Women who reported
prejudicial experiences tended to be black, lesbian, or educated at the

The general perception that prejudice was a factor in health care delivery did
not deter women from following mammogram, PAP smear, or breast self-examination
screening guidelines, but personal experiences with prejudice did.  For
example, women who experienced prejudice directed toward themselves were more
likely to perform breast self-examinations infrequently, if at all.  Lack of
money or health insurance also influenced a woman’s decision to forgo the
proper screening, said Facione.

“The observed relationship between reported experience of prejudice in care
delivery and lower adherence rates to screening guidelines demands further
study,” said Facione.  “Our study recruited many women who are disconnected
from the promise of early cancer detection, in part due to perceived prejudice
from their health care providers.  If perceived prejudice negatively influences
a woman’s health care behavior, providers need to start correcting for it.”

The researchers also found that nearly 20 percent of the women in the study
reported not getting a PAP smear every one to two years and most failed to
perform monthly breast self-examinations, as recommended by national

The symposium on women’s quality of life will also include research on the
perceived quality of life of diabetic Palestinian refugee women in Jordan, the
impact of cultural mourning practices on bereaved women in Botswana, Philipino
women’s perspectives on health and health care, and the impact of intimate
relationships on homeless women’s health and well-being in the United States.