This project proposes to identify specific factors that influence mammography services utilization among African-American women age 50 and older in a low income urban community, and to identify factors associated with consistent screening attendance compared to onetime or irregular use. Although it is known that low income, older, African-American women are at risk for poor screening patterns, late- stage diagnosis and associated mortality from breast cancer, less information is available on what distinguishes women in this high risk group who receive regular screening and follow-up and those who do not. Of particular concern are women who may believe themselves to be adequately screened, and yet have received only sporadic screening mammograms without adequate follow-up. The objectives of the proposed study are to gather information on the knowledge, attitudes, prior health care utilization patterns, and screening histories of women attending a breast cancer screening program, and compare this information to a matched sample of women within the same community who do not attend the screening program. The investigators hypothesize that there will be important differences between cases and controls in each of six areas (cancer beliefs, physical health, belief models of disease and healing, social sphere, healthcare use, and prior screening). The identification of sociological, behavioral and health care access factors associated with low rates of screening will lead to recommendations for specific areas for intervention, aimed at increasing the use of regular screening and follow up among the women currently lacking adequate screening. In this three year project, the investigators will conduct personal interviews with 400 African-American women age 50+ who enter the Johns Hopkins Breast Center Community Health Program for screening. The 40 minute interview, containing both open-ended and structured measures, will collect information on each woman's perceptions of the burden of breast cancer and its treatment, current and prior health status, health care utilization, and psychosocial well-being. Each woman will also be asked to nominate five women to serve as potential 'controls'; friends or neighbors of the same age who are not currently receiving regular mammography screening. 400 control interviews (one per case) will be conducted. A matched case-control analysis during Year Three will identify factors associated with screening. The investigators will also compare women who attend consistently to those screened only once. Results from the project will be used with the East Baltimore Community to increase screening attendance, and shared with state and national organizations working with older, low income, and minority women's health. One additional immediate benefit will be to educate and potentially recruit all nominated controls to attend the Breast Center Screening Program.
