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College of Public Health

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JOHNSON CITY Despite the encouraging treatment options for patients diagnosed with breast cancer, many women perceive the disease as fatal and, as a result, do not participate in routine screening practices such as mammograms and clinical breast exams, according to a study published in the current issue of the Journal of Health Care for the Poor and Underserved.

We call this cancer fatalism, a belief system whereby people assume that a cancer diagnosis is a death sentence, said Dr. Amal Khoury, interim chair of health services administration in East Tennessee State Universitys College of Public Health.  That fatalistic view has become a major barrier to accessing life-saving preventive services.

Understanding factors that contribute to cancer fatalism was the goal of a major population-based study that Khoury, a lead investigator in the project, describes as one of the largest of its kind involving more than 1,000 women age 40 or older.

It is easy to assume that this fatalistic view is driven by socioeconomic issues, such as a lack of health insurance, and, in fact, those are major factors, Khoury explained. The study found that fatalism was most common among low-income and low-education populations as well as among African American women.

But Khoury said two other issues emerged that, combined with the socioeconomic dynamic, served as the foundation for cancer fatalism.

Perceptions of the health care system proved to be a significant risk factor for fatalism, she said. Women who rated their quality of care as fair or poor, and women who mistrusted the health care system, were twice as likely to believe that cancer was a death sentence.

Approximately 80 percent of women who were surveyed indicated that health insurance affected the kind of care that a person received, Khoury noted, and nearly two-thirds believed that better health care was delivered to wealthy people.  There was also a high prevalence of perceived racism.

Khoury recommends that health care organizations work to improve patient experiences and satisfaction with care.

This is necessary to build trust of the system within the community, thus encouraging greater use of appropriate services, she added.

A lack of knowledge about early detection also influences fatalism.

Whether it is through one-on-one conversations with providers, community-based programs, or media campaigns, the message about detection should continue to be loud and clear, especially among vulnerable populations.  The researchers believe educational programs should highlight positive survival experiences and promote the view that survival is possible through early detection.

The survey was conducted in Mississippi where 80 percent of the counties are classified as rural communities and 56 percent of the population resides in a rural area.

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