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College of Public Health

Dr. Amal Khoury

JOHNSON CITY A new study by an East Tennessee State University professor reveals that access to health care is the primary factor that influences whether women receive regular mammograms.

 Dr. Amal Khoury, interim chair of the Department of Health Services Administration in ETSUs College of Public Health, co-authored the study, which is published in the latest edition of Womens Health Issues, the leading academic journal for womens studies.

While access to health care is the overriding factor for women to keep to a mammogram schedule, Khoury said it is hardly the only one. Race, especially where African Americans are concerned, also plays a part, as does a sense of fatalism for some women.

 The researchers surveyed a broad cross-section of 1,000 women in Mississippi, and Khoury said the socioeconomic and racial diversity of the survey sample makes the conclusions relevant to many areas of the South, including the Appalachian region.

 We took a very comprehensive approach to the study, and access to care emerged as the primary predictor for screening, Khoury said. And when you dig down deeper into those issues, its easier to understand where changes could be made so more women would have mammograms.

 For example, 90 percent or more of women who were current on mammograms had health insurance, a usual source of health care and annual medical checkups. However, only two out of three women who had never had a mammogram reported having health insurance, and only 43 percent of those women had annual medical checkups.

 A medical providers recommendation also matters. Two out of three women who had never had a mammogram reported that their doctor had not encouraged them to get a mammogram nor talked with them about breast cancer.  

 The researchers also found that even when African American women had access to care, they were four times more likely than white women to have never obtained a mammogram.

 There were cultural barriers and mistrust issues with the health care system among some African Americans, Khoury said, and with some, there were references to racism in the health care system.

 And some women struggled with the fatalistic view that nothing could be done to prevent breast cancer. Those women reported that receiving a mammogram was pointless because, even if breast cancer were found, treatment costs would make the result irrelevant.

 They saw access to treatment for breast cancer as a barrier, Khoury said, so those women did not get mammograms. They were concerned they could not afford the treatment.

 Countless people spend one month each year marking Breast Cancer Awareness Month. But Khoury said its important to remember, each and every month, that breast cancer is the second leading cause of cancer death for women, and that regular mammograms are the gold standard for early detection.

 Early detection of breast cancer is a key to reducing death from the disease, Khoury said. Thats why its so important that we eliminate some of the barriers preventing women from getting regular mammograms.

 Khoury conducted the study with colleagues Ellen Lopez, a faculty member at the University of Alaska Fairbanks, and University of Florida faculty members Amy Dailey, Allyson Hall and Latarsha Chisholm.

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