Breast Cancer Beliefs Research Articles

Does a Bite Cause Cancer? Misperceptions of Breast Cancer Etiology among Low-Income Urban Women in Miami, Florida

To explore breast cancer beliefs among a cohort of low-income, urban, English-speaking women in Miami, Florida, who had undergone screening mammography. Four focus groups of 34 women were conducted. Discussions were transcribed verbatim and transcripts were analyzed separately by two investigators using an immersion-and-crystallization approach. Common risk factors were identified by consensus. Participants were predominantly African American (82%) women of low income (77% with a household income <$20,000/year). Common risk factors included family history, environmental factors, trauma, and sexual activity. There also was a perception that breast cancer grows rapidly and causes detectable symptoms. Women voiced some accurate and numerous inaccurate beliefs regarding the causes of breast cancer, suggesting a lack of knowledge about the potential benefits and harms of screening mammography before undergoing examination. These findings highlight the importance of identifying women's underlying beliefs when initiating a discussion of breast cancer screening and prevention to ensure that messages are mutually understood.

Abstract B42: Examining factors associated with high levels of breast cancer beliefs among Hispanic women.

Abstract Purpose: Certain cultural beliefs related to breast cancer may act as a barrier to a woman seeking breast cancer preventive services or timely follow-up for a breast symptom. In the Breast Cancer Care in Chicago study, Hispanic patients held considerably more cultural beliefs compared to African-American or non-Hispanic White patients. For Hispanics, holding beliefs that are inconsistent with health care seeking behavior may lead to low or delayed utilization of care regardless of access. This study explores factors associated with breast cancer beliefs among Hispanic women and how this might impact their screening and health seeking behavior. Methods: Data were obtained from a population-based sample of 181 urban Hispanic women recruited as part of the Breast Cancer Care in Chicago study. Women were ages 30-79 and had been diagnosed with primary in situ or invasive breast cancer. Interviews included a 15 item cultural beliefs scale spanning a range of beliefs regarding the meaning of a breast lump, importance of treatment, and the role of faith – beliefs that could be inconsistent with motivation to seek timely health care (inter-item correlation = 0.82). We dichotomized the total number of beliefs at the sample median, such that patients holding 3 or more beliefs (index) were compared to patients holding fewer than 3 beliefs (referent). Potential sociodemographic predictors were examined, as were census tract measures of cultural isolation, disadvantage and affluence. Prolonged presentation delay and prolonged clinical delay were each defined as delay exceeding the sample median (77 and 90 days, respectively) from symptom awareness to first clinical visit and from first clinical visit to first treatment for breast cancer, respectively. Results: Overall, 44% of the women in the sample held three or more beliefs related to breast cancer. The beliefs most commonly held were: 1) Faith in God can protect you from breast cancer (48%), 2) If a breast lump is touched or pressed often, the lump will turn out to be breast cancer (30%), and 3) If breast cancer is cut open in surgery, it will grow faster (28%). Lower socioeconomic status and lower levels of acculturation were associated with greater beliefs. Patients with less income and education and lacking private health insurance tended to hold more beliefs. Women who were older, born outside the U.S., did not speak English as a primary language, or whose parents were less educated or born outside the U.S., were more likely to hold higher levels of beliefs (p&amp;lt;0.05). Contrary to expectation, census tract measures of cultural isolation, disadvantage and affluence were not associated with beliefs. Possessing a greater number of beliefs was associated with delays in seeking and receiving health care for breast cancer. Prolonged presentation delay was more common among patients with greater number of beliefs than with fewer beliefs (41% vs. 17%, p=0.008). Likewise, prolonged clinical delay was more common for women holding a greater number of beliefs vs. fewer beliefs (41% vs. 24%, p=0.045). Conclusions: Cultural beliefs may predispose certain Hispanic women who are less acculturated and of lower socioeconomic status to delay seeking health care for breast cancer related symptoms. Citation Format: Rani I. Gallardo, Garth H. Rauscher, Carol E. Ferrans. Examining factors associated with high levels of breast cancer beliefs among Hispanic women. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B42.

Development of the Thai Breast Cancer Belief Scale for Thai Immigrants in the United States

Asian American women have not benefited from the decline in breast cancer mortality and have lower rates of mammography use. Understanding mammography behaviors among these Asian American women requires culturally specific measures. Champion's belief scale was translated into Thai and cultural items were added. The Thai breast cancer belief scale (TBCBS), the Suinn-Lew self-identification acculturation, and the Asian values scale-revised were administered to 250 Thai immigrants. The TBCBS was tested for face validity, construct validity, and internal consistency. Factor analysis reflected the 4 constructs of the health belief model and accounted for 45.8% of the variance. Cronbach's alpha ranged from .77 to .90. Modest correlations were observed between TBCBS subscales and acculturation scales. Results indicate that the TBCBS measures breast cancer beliefs among Thai immigrant population.

Impact of a community-based breast cancer screening program on Hopi women

ObjectiveTo examine changes in breast cancer knowledge, attitudes, beliefs and behaviors following implementation of a tribal run CDC Breast and Cervical Cancer Program (BCCP), we report 2006 survey results from Hopi women and contrast findings with 1993 survey data and BCCP reports. MethodsCommunity meetings, focus groups, and researchers jointly developed a culturally appropriate survey instrument. Hopi women randomly selected from Tribal enrollment lists were interviewed in-person by Hopi interviewers; 250 women ≥age 18 participated (87% response) between June and December, 2006. ResultsAmong women 40+, 77.5% reported ever having had a mammogram and 68.9% reported having done so within the past 2years, an increase from 45.2% and 46% self-reported in 1993. Compared to 1993, more women in 2006 (88.1% vs. 59%) believed that a mammogram can detect cancer and more than 90% now believe that early detection of cancer can save lives. Women reported a preference (60%) for receiving health care at the Hopi BCCP. Survey results were validated using programmatic data which estimated 76.6% of Hopi women had received mammography screening. ConclusionImplementation of a tribal run BCCP has resulted in a substantial increase in mammography screening on the Hopi reservation.

Breast cancer health promotion in Qatar: a survey of community pharmacists’ interests and needs

Breast cancer is the most common cancer in women in Qatar. Despite the sustained efforts to increase breast cancer public awareness via campaigns and public screening programmes, breast cancer screening rate remains low. The involvement of community pharmacists in the communication and distribution of breast cancer screening information should have a significant positive impact. The objectives of this study were to determine the degree of community pharmacists' involvement in breast cancer health promotion activities in Qatar, to explore their attitudes towards the involvement in breast cancer health promotion, to assess their breast cancer knowledge, to gauge their interest in receiving breast cancer continuous education and to list their perceived barriers for including breast cancer health promotion activities into their daily practice. Community pharmacies in Qatar. The study objectives were addressed in a cross-sectional survey of all community pharmacists in Qatar. The extent of community pharmacists' involvement in breast cancer health promotion activities, the community pharmacists' interest and comfort in providing breast cancer health promotion, their breast cancer knowledge, their interest in receiving breast cancer continuous education, their attitudes and beliefs towards breast cancer health promotion and their perceived barriers for integrating breast cancer heath promotion activities into their daily practice. Over a 12-week period, we collected 195 surveys (60% response rate). Eighty-eight percent indicated that they never invited healthcare professionals to provide breast cancer education in the pharmacy, 78% said that they never distributed breast cancer educational materials, and 58% reported that they never counseled patients about breast cancer. Nevertheless, more than 60% were highly interested in being engaged in breast cancer health promotion activities. In addition, 87% believed that discussing breast cancer awareness with female patients in the pharmacy was beneficial to patients. Yet pharmacists perceived many barriers for integrating breast cancer health promotion into their daily practice including lack of educational materials (79%) and lack of public recognition (61%). Moreover, their breast cancer knowledge mean score was 63% with 77% expressing a high interest in receiving breast cancer continuous education. Despite their low involvement in breast cancer health promotion, the majority of pharmacists were interested in educating patients about breast cancer. However, low breast cancer knowledge and other barriers can prevent actualizing this role. Further work should focus on providing these pharmacists with breast cancer continuous education and overcoming all stated barriers.

Breast cancer health promotion in Qatar: a survey of community pharmacists’ interests and needs

Breast cancer is the most common cancer in women in Qatar. Despite the sustained efforts to increase breast cancer public awareness via campaigns and public screening programmes, breast cancer screening rate remains low. The involvement of community pharmacists in the communication and distribution of breast cancer screening information should have a significant positive impact. The objectives of this study were to determine the degree of community pharmacists' involvement in breast cancer health promotion activities in Qatar, to explore their attitudes towards the involvement in breast cancer health promotion, to assess their breast cancer knowledge, to gauge their interest in receiving breast cancer continuous education and to list their perceived barriers for including breast cancer health promotion activities into their daily practice. Community pharmacies in Qatar. The study objectives were addressed in a cross-sectional survey of all community pharmacists in Qatar. The extent of community pharmacists' involvement in breast cancer health promotion activities, the community pharmacists' interest and comfort in providing breast cancer health promotion, their breast cancer knowledge, their interest in receiving breast cancer continuous education, their attitudes and beliefs towards breast cancer health promotion and their perceived barriers for integrating breast cancer heath promotion activities into their daily practice. Over a 12-week period, we collected 195 surveys (60% response rate). Eighty-eight percent indicated that they never invited healthcare professionals to provide breast cancer education in the pharmacy, 78% said that they never distributed breast cancer educational materials, and 58% reported that they never counseled patients about breast cancer. Nevertheless, more than 60% were highly interested in being engaged in breast cancer health promotion activities. In addition, 87% believed that discussing breast cancer awareness with female patients in the pharmacy was beneficial to patients. Yet pharmacists perceived many barriers for integrating breast cancer health promotion into their daily practice including lack of educational materials (79%) and lack of public recognition (61%). Moreover, their breast cancer knowledge mean score was 63% with 77% expressing a high interest in receiving breast cancer continuous education. Despite their low involvement in breast cancer health promotion, the majority of pharmacists were interested in educating patients about breast cancer. However, low breast cancer knowledge and other barriers can prevent actualizing this role. Further work should focus on providing these pharmacists with breast cancer continuous education and overcoming all stated barriers.

The obscuring object of race: Clinical breast exams and coping styles in ethnic subpopulations of women

Differences in breast cancer screening rates have been linked to many factors including race, access to healthcare, and breast cancer knowledge and beliefs; less frequently studied has been the role of characteristic styles of coping. In this study, we examined ethnicity and the role of coping with a possible breast cancer diagnosis in the context of whether or not women obtained clinical breast examinations (CBE). To measure coping, a stressor, in the form of a vignette asking participants to imagine they had just received a breast diagnosis upon a doctor's visit, was used. Three hundred and eight women from seven ethnic subpopulations (and from three racial groups) in the USA were interviewed regarding frequency of breast screening, as well as how they would likely cope with a diagnosis of breast cancer. CBE rates were similar across groups and were differentially predicted by the different coping styles. Analysing the results using typical racial categories (rather than distinct ethnic groupings) obscured these results. Furthermore, avoidance predicted CBE and mammogram rates differently, specifically, predicting mammogram rates differentially for each group, with no relation to CBE rates. Recognition of the roles of problem solving, social support, and avoidance in coping with a possible breast cancer diagnosis may guide the development and provision of interventions that are more sensitive to the characteristics of specific groups of women. Examinations of psychological variables in preventive health behaviours must begin to analyse diversity by paying attention to ethnic specificity, rather than race, as well as to the underlying nature of the screening task.

Chinese Breast Cancer Screening Beliefs Questionnaire: development and psychometric testing with Chinese‐Australian women

This paper is a report of the development and psychometric testing of the Chinese Breast Cancer Screening Beliefs Questionnaire, a culturally sensitive questionnaire for measuring Chinese-Australian women's beliefs, knowledge and attitudes towards breast cancer and breast screening practices. Breast cancer is the leading cause of cancer morbidity among Chinese-Australian women. They are, however, 50% less likely to participate in all types of breast examination. A valid and reliable instrument to explore the breast cancer beliefs is essential for the development of interventions to promote breast cancer screening practices. Items for the questionnaire were drawn from a literature review and in-depth interviews. A panel of professional experts and lay women evaluated face and content validity. The instrument was translated from English to Chinese using back-translation. In 2008, a total of 292 Chinese-Australian women aged 22-78 years who were resident of Australia were included in testing the instrument. Multi-trait analysis and Cronbach's alpha were used to assess internal consistency reliability and exploratory factor analysis assessed construct validity. The final 13-item questionnaire had satisfactory validity and internal consistency. Cronbach's alpha for the total scale was 0.76, and for the three subscales ranged from 0.70 to 0.79. Exploratory factor analysis showed that the scale reduced to three factors. Preliminary data suggest that the Chinese Breast Cancer Screening Beliefs Questionnaire is a valid, reliable and culturally sensitive instrument for the measurement of Chinese-Australian women's beliefs, knowledge and attitudes about breast cancer and breast cancer screening.

Assess the Effects of Culturally Relevant Intervention on Breast Cancer Knowledge, Beliefs, and Mammography Use Among Korean American Women

A pre-post test, two-group study was conducted to examine the effects of a culturally competent targeted intervention titled GO EARLY Save Your Life on the breast cancer and early screening-related knowledge and beliefs and mammography use among 180 Korean American (KA) women aged 40 years or older who had not had mammograms within the past 12 months. The intervention group received an interactive education session focused on breast cancer, early screening guidelines, and beliefs (breast cancer-related and Korean cultural beliefs). The control group received no education. There was no statistically significant intervention effect on mammography use between the intervention (34%) and control groups (23%) at 24 weeks post baseline. The rates of mammography use for both groups significantly increased from 16 to 24 weeks post baseline. The education was effective in increasing breast cancer/early screening-related knowledge and modifying beliefs (decreasing barriers, fear, seriousness, and fatalism, and increasing preventive health orientation).

Measuring Mammography and Breast Cancer Beliefs in African American Women

Although intervention trials have demonstrated significant improvement in mammography adherence for African American women, many of the current measurement tools used in these interventions have not been assessed for validity and reliability in ethnic minorities. This study assessed the validity and reliability of Health Belief Model (HBM) variables that are often the target of mammography interventions. Scale validity and reliability was assessed for HBM scales in a sample of 344 low-income African American women. Validity was supported through exploratory factor analysis and theoretical prediction of relationships. Internal consistency reliability was .73 or above for all scales.

Tailored lay health worker intervention improves breast cancer screening outcomes in non-adherent Korean-American women.

Despite rapidly increasing incidence rates of breast cancer, recent immigrants such as Korean-American (KA) women report disproportionately lower utilization of screening tests compared with other ethnic groups. Early screening of breast cancer for this population may be greatly facilitated by indigenous lay health workers (LHWs). We conducted an intervention trial with a 6-month follow-up. Trained LHWs recruited 100 KA women 40 years of age or older who had not had a mammogram during the past 2 years. Ninety-three completed follow-up questionnaires. A 120-min, in-class education combined with LHW follow-up counseling and navigation assistance through the health care system was provided. Rates of breast cancer screening behaviors significantly increased at 6 months (P < 0.001); changes between pre- and post-intervention were 31.9% for mammography, 23% for clinical breast examination and 36.2% for breast self-examination. Modesty toward screening significantly decreased over time, but we did not find any significant differences in breast cancer knowledge and beliefs before and after the intervention. Results support the efficacy of this neighborhood-based, culturally sensitive intervention. Further research should seek to replicate these findings and to incorporate more self-care skills such as health literacy when designing an intervention program for linguistically and culturally isolated immigrant women.

Fatalism or Destiny? A Qualitative Study and Interpretative Framework on Dominican Women’s Breast Cancer Beliefs

A growing literature on Latino's beliefs about cancer focuses on the concept of fatalismo (fatalism), despite numerous conceptual ambiguities concerning its meaning, definition, and measurement. This study explored Latina women's views on breast cancer and screening within a cultural framework of destino ("destiny"), or the notion that both personal agency and external forces can influence health and life events. Semi-structured interviews were conducted with 25 Latinas from the Dominican Republic aged 40 or over. Respondents reported complex notions of health locus of control that encompassed both internal (e.g., individual action) and external (e.g., the will of God) forces shaping breast cancer prevention efforts. Furthermore, women actively participated in screening because they believed that cancer could become a death sentence if diagnosed late or left untreated. In contrast to simplistic notions of "fatalism", our analysis suggests complex strategies and beliefs regarding breast cancer and cancer screening that speak of resiliency rather than hopelessness.

Effects of a Culturally Sensitive Education Program on the Breast Cancer Knowledge and Beliefs of Hispanic Women

To determine the effectiveness of a multifaceted, culturally sensitive, and linguistically appropriate breast cancer education program for Hispanic women. Experimental (post-test only, control-group design). The parish hall of a Roman Catholic Church in northeastern Arkansas. 31 Hispanic women aged 25-56 residing in northeastern Arkansas. The experimental group received a multifaceted, culturally sensitive, and linguistically appropriate breast cancer education program; the control group received general nutritional information. Both groups completed the Breast Cancer Knowledge Test and Breast Cancer Screening Belief Scales so that the researchers could measure dependent variables. Data were analyzed with t tests. Knowledge of and beliefs about breast cancer. The experimental group scored significantly higher on the Breast Cancer Knowledge Test than did the control group. The control group scored significantly higher than the experimental group on the barriers to mammography scale and the benefits of breast self-examination scale of the Breast Cancer Screening Belief Scales. The multifaceted, culturally sensitive, and linguistically appropriate breast cancer education program appeared to be responsible for increased knowledge of breast cancer and reduced barriers to mammography. Education may change Hispanic women's knowledge and beliefs about breast cancer. An intervention designed and implemented by nurses can play a significant role in meeting the strong need for culturally sensitive and linguistically appropriate breast cancer educational programs for Hispanic women. Such programs should focus on helping Hispanic women understand their personal risks related to breast cancer and reduce barriers they perceive to early screening and detection.

Breast Cancer Beliefs and Mammography Screening Practices Among Chinese American Immigrants

To explore knowledge and beliefs (perceived risk factors, susceptibility, benefits, common barriers, and cultural barriers) in relation to mammography screening practices among Chinese American women. A descriptive study guided by the Health Belief Model. Metropolitan area in the northwestern United States. One hundred Chinese immigrant women, 40 years or older. The percentage of Chinese American women ages 40 and older who ever received a mammogram and who received a mammogram within the past year. Although 86% of the respondents reported that they had once had a mammogram, only 48.5% had a mammogram within the past year. The strongest factor associated with having a mammogram within the past year was having an immediate family member diagnosed with breast cancer, followed by having insurance that covered a mammogram and lower perceived barriers to obtaining a mammogram. Respondents had low knowledge of breast cancer and mammography screening guidelines. They also perceived low susceptibility to breast cancer. Nurses may influence the mammogram rates among Chinese American women by providing health education to family members of patients with breast cancer, reducing perceived barriers to mammogram, and seeking alternative payment mechanisms for patients who do not have insurance coverage for mammogram.

Health Belief Model Variables as Predictors of Progression in Stage of Mammography Adoption

Identify predictors of change in mammography stage for nonadherent women so that appropriate stage-based interventions can be developed. Participants were randomly assigned to one of four groups in a randomized clinical trial to increase mammography screening. This report focuses on predictors of stages of change of mammography behavior; intervention results are reported elsewhere. Indigent clinic and health maintenance organization. Women, 50 or older, with no breast cancer diagnosis and nonadherent with mammography screening. The intervention and results are described elsewhere. Previously validated belief scales. Results showed that precontemplators and contemplators differed significantly at baseline and follow-up on all breast cancer beliefs except fear. Changes in barriers, benefits, and self-efficacy scores significantly predicted forward stage movement for women entering the study in precontemplation or contemplation (p = .0009, p = .037, and p = .048, respectively). Changes in beliefs predict stage movement, and beliefs differ significantly among stages, leading the way for interventions tailored to both beliefs and stages of behavior adoption. In practical terms, we may be able to cut down on the "bulkiness" of our interventions and the number of tailoring variables, focusing more intensively on tailoring interventions to the beliefs whose changes have now been shown to predict stage advancement. These predictions are in addition to intervention effect which is reported elsewhere.

Assessing Breast Cancer Knowledge, Beliefs, and Misconceptions Among Latinas in Houston, Texas

Limited breast cancer knowledge and beliefs, risk factors, screening procedures, and cultural barriers may keep Latinas from seeking health care. We examined the breast cancer knowledge, beliefs, and misconceptions of 63 Latinas residing in Houston, Texas. More than a third of participants held a negative or fatalistic view of breast cancer, 29% believed pain was a warning sign for the disease, and 11.1% had never heard of breast cancer. Our findings indicate this population holds many misconceptions about breast cancer, which may have a negative impact on preventive behaviors on this minority population.

Women's opinions about attending for breast cancer screening: Stability of cognitive determinants during three rounds of screening

To examine the stability of beliefs and intentions towards repeat attendance at breast cancer screening, using the Theory of Planned Behaviour. The aims of the study were to examine whether and how cognitions changed in the course of the programme, and whether intentions that were assessed proximally were better predictors of behaviour than those assessed distally. A total of 2,657 women filled out a baseline questionnaire (T(1)), 2 months after being invited for an initial mammogram in the Dutch Breast Cancer Screening Programme. Actual attendance data in the second and third screening rounds were subsequently collected and follow-up questionnaires were sent to parts of the sample at four points in time: shortly before (T(2)) and after (T(3)) the second screening round, and shortly before (T(4)) and after (T(5)) the third screening round. Only minor changes in beliefs and intentions were found. In the assessments shortly before screening, women were somewhat less positive about attending than in the assessments shortly after screening. Throughout the course of the programme, women's opinions about attending remained positive. In fact, women became somewhat more convinced that they were vulnerable to getting breast cancer, and that participating in screening was beneficial to them. Actual attendance in subsequent rounds of screening was higher than expected. Proximal beliefs and intentions were only slightly more predictive of actual behaviour than distal beliefs. In organized breast cancer screening, beliefs and intentions remain positive and rather stable. Although our results should be interpreted with caution, due to little variation in behaviour, they suggest that the gap between intentions and behaviour could not be substantially reduced by proximal assessment of determinants.

Family Influences on Food Choice: Context of Surviving Breast Cancer

Objective To explore women's perceptions of family influences on food decision-making in the context of having had breast cancer or not having had breast cancer. Design Individual interviews exploring women's perceptions of their eating habits, health status, and diet, health, and breast cancer beliefs. Setting In Vancouver, a large, multicultural, Canadian city, interviews were held in women's homes or offices or at the university. Participants A culturally diverse convenience sample of women aged 40 to 60 years, including breast cancer survivors (n = 29) and women who had not had breast cancer (n = 32). Analysis Verbatim interview transcripts were coded by one of the authors, and themes were developed by sorting and summarizing transcript segments. Results Women who had not had breast cancer believed that they were catering to family preferences, even at the expense of their own health. In particular, men's “meat and potatoes” diet proved to be a barrier to dietary change. Breast cancer survivors experienced family members more as supporting than resisting healthful eating. Believing that the diagnosis had shifted their priorities, some women made healthful dietary changes regardless of family response. Conclusions and Implications Women experience family influence as significant in food decision-making. An illness diagnosis may alter women's and their families' negotiations of competing values, such that healthful eating takes on greater priority than food preferences or maintaining social relations through catering to others' tastes. This may be an opportune time to help women introduce healthful eating.

Breast cancer knowledge and beliefs in subpopulations of African American and Caribbean women.

To examine breast cancer belief and knowledge deficits among previously unstudied African and Caribbean subpopulations and to consider the particular knowledge and belief components that are most lacking in each group. 1,364 African American, US-born white, English-speaking Caribbean, Haitian, Dominican, and Eastern European women were recruiting via stratified-cluster sampling. Participants provided demographics and measures of beliefs and knowledge. There were between-group differences in cancer knowledge and beliefs and within-group variation in terms of which particular knowledge and belief items varied. Studying how cognitive factors relate to screening in well-defined minority groups will capacitate interventions suited to the knowledge and belief deficits that characterize populations of diverse women.

African American women's breast memories, cancer beliefs, and screening behaviors.

African American women experience higher breast cancer mortality and lower survival rates compared with white women of comparable age and cancer stage. The literature is lacking in studies that address the influence of past events on current health behaviors among women of diverse cultural groups. This qualitative exploratory study used participant narratives to examine associations between women's memories and feelings concerning their breasts and current breast cancer screening behaviors. Twelve professional African American women, aged 42 to 64 years, shared stories about memories and feelings regarding their breasts. Codes grouped together with related patterns and recurrences revealed categories that encompassed the language and culture of the participants. The categories identified were Seasons of Breast Awareness, Womanhood, Self-Portraits, Breast Cancer and Cancer Beliefs, Breast Cancer Screening Experiences, and Participants' Advice for Change. These categories provide direction for further exploration of barriers to health promotion practices among African American women and women in general.