By Lisa Rapaport

(Reuters Health) – African American women with abnormal mammograms may be less likely than those from other ethnic and racial groups to recognize the barriers to follow-up care that can delay a breast cancer diagnosis or to seek help overcoming them, a U.S. study suggests.

Many barriers to obtaining routine screening mammograms – whether it’s lack of insurance, transportation or awareness – can contribute to delayed breast cancer diagnoses and lead to lower survival odds, researchers note in the journal Cancer.

While previous research has found that black women are more likely to be diagnosed with breast cancer when it’s advanced and harder to treat, less is known about how women’s awareness of their own barriers to healthcare might impact their outcomes.

For the current study, researchers examined data on 3,754 women who were seen at Chicago hospitals serving low-income neighborhoods who required follow-up care for abnormal mammogram results. All of the women spoke to patient navigators who helped assess potential barriers to care, explain treatment options, schedule appointments and provide psychological and social support.

Overall, just 14 percent of women identified one or more barriers to care – including financial, scheduling or interpersonal issues and other obstacles interfering with their ability to follow-up on the mammogram result. This resulted in additional support from patient navigators to help them get the additional tests they needed.

But researchers found that black women, poor women, and women with deep distrust of the healthcare system were less likely than other groups to report having any barriers to care that might trigger extra help from navigators.

“Healthcare providers are striving to reduce health disparities in the extremely complex U.S. healthcare system, and patient navigators are a recent innovation that has been proven cost effective and useful to help women obtain timely follow-up of abnormal tests and early diagnosis,” said lead study author Sage Kim of the University of Illinois at Chicago.

But this resource only works if women know navigators are available and take advantage of the extra help, Kim said by email.

“Healthcare providers need to be more proactive because when women report no barrier, it may not be that they don’t encounter barriers,” Kim added. “It may require just asking another question or approaching a different way to get at what many women face in their everyday life.”

Almost half of women who reported barriers to care in the study went on to get at least some follow-up screening or testing, the study found.

But just 31 percent of women who reported no barriers to care got follow-up screening or tests.

Black women were less likely overall to report barriers to care than white or Hispanic women in the study.

And while poor women were generally more likely to report barriers than more affluent women, black women living in poverty were less likely to report barriers.

The study wasn’t designed to determine whether or how reporting barriers to care or working with patient navigators might directly impact breast cancer outcomes. It also did not examine whether not reporting barriers is a result of not recognizing them.

Still, the results suggest that gender, race, ethnicity and class may all shape how women deal with barriers to care, the study authors conclude.

“What our findings are saying is that care providers need to be aware of the fact that not all women interact the same with patient navigators and other care providers,” Kim said.

“Racialized gender images of the ideal women and medical distrust due to historical experiences of discrimination, such as the Tuskegee experiment, affect how minority women, particularly living in poverty, interact and utilize healthcare,” Kim added. “Providers need to be aware of such social and historical conditions that may affect the effectiveness of interventions, including patient navigators, for minority women.”

SOURCE: Cancer, online September 24, 2018.