A systematic review of barriers to early presentation and diagnosis with breast cancer among black women
Objective To explore barriers to early presentation and diagnosis with breast cancer among black women.Design Systematic review.Methods We searched multiple bibliographic databases (January 1991–February 2013) for primary research, published in English, conducted in developed countries and investiga...
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BMJ Publishing Group
2014-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/4/2/e004076.full |
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| author | Ruth H Jack Jill Maben Elizabeth A Davies Emma Ream Grace Lucas Claire EL Jones Lindsay JL Forbes |
| author_facet | Ruth H Jack Jill Maben Elizabeth A Davies Emma Ream Grace Lucas Claire EL Jones Lindsay JL Forbes |
| author_sort | Ruth H Jack |
| collection | DOAJ |
| description | Objective To explore barriers to early presentation and diagnosis with breast cancer among black women.Design Systematic review.Methods We searched multiple bibliographic databases (January 1991–February 2013) for primary research, published in English, conducted in developed countries and investigating barriers to early presentation and diagnosis with symptomatic breast cancer among black women (≥18 years). Studies were excluded if they did not report separate findings by ethnic group or gender, only reported differences in time to presentation/diagnosis, or reported on interventions and barriers to cancer screening. We followed Cochrane and PRISMA guidance to identify relevant research. Findings were integrated through thematic synthesis. Designs of quantitative studies made meta-analysis impossible.Results We identified 18 studies (6183 participants). Delay was multifactorial, individual and complex. Factors contributing to delay included: poor symptom and risk factor knowledge; fear of detecting breast abnormality; fear of cancer treatments; fear of partner abandonment; embarrassment disclosing symptoms to healthcare professionals; taboo and stigmatism. Presentation appears quicker following disclosure. Influence of fatalism and religiosity on delay is unclear from evidence in these studies. We compared older studies (≥10 years) with newer ones (<10 years) to determine changes over time. In older studies, delaying factors included: inaccessibility of healthcare services; competing priorities and concerns about partner abandonment. Partner abandonment was studied in older studies but not in newer ones. Comparisons of healthy women and cancer populations revealed differences between how people perceive they would behave, and actually behave, on finding breast abnormality.Conclusions Strategies to improve early presentation and diagnosis with breast cancer among black women need to address symptom recognition and interpretation of risk, as well as fears of the consequences of cancer. The review is limited by the paucity of studies conducted outside the USA and limited detail reported by published studies preventing comparison between ethnic groups. |
| format | Article |
| id | doaj-art-9e295d2164cc4d6a86bb6de91520233d |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2014-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-9e295d2164cc4d6a86bb6de91520233d2025-02-07T08:05:14ZengBMJ Publishing GroupBMJ Open2044-60552014-02-014210.1136/bmjopen-2013-004076A systematic review of barriers to early presentation and diagnosis with breast cancer among black womenRuth H Jack0Jill Maben1Elizabeth A Davies2Emma Ream3Grace Lucas4Claire EL Jones5Lindsay JL Forbes61 Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UKSchool of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UKKnowledge and Intelligence, Public Health England, London, UKSchool of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UKKing`s College London, Florence Nightingale School of Nursing and Midwifery, London, UKKing`s College London, Florence Nightingale School of Nursing and Midwifery, London, UKPromoting Early Presentation Group, King`s College London, London, UKObjective To explore barriers to early presentation and diagnosis with breast cancer among black women.Design Systematic review.Methods We searched multiple bibliographic databases (January 1991–February 2013) for primary research, published in English, conducted in developed countries and investigating barriers to early presentation and diagnosis with symptomatic breast cancer among black women (≥18 years). Studies were excluded if they did not report separate findings by ethnic group or gender, only reported differences in time to presentation/diagnosis, or reported on interventions and barriers to cancer screening. We followed Cochrane and PRISMA guidance to identify relevant research. Findings were integrated through thematic synthesis. Designs of quantitative studies made meta-analysis impossible.Results We identified 18 studies (6183 participants). Delay was multifactorial, individual and complex. Factors contributing to delay included: poor symptom and risk factor knowledge; fear of detecting breast abnormality; fear of cancer treatments; fear of partner abandonment; embarrassment disclosing symptoms to healthcare professionals; taboo and stigmatism. Presentation appears quicker following disclosure. Influence of fatalism and religiosity on delay is unclear from evidence in these studies. We compared older studies (≥10 years) with newer ones (<10 years) to determine changes over time. In older studies, delaying factors included: inaccessibility of healthcare services; competing priorities and concerns about partner abandonment. Partner abandonment was studied in older studies but not in newer ones. Comparisons of healthy women and cancer populations revealed differences between how people perceive they would behave, and actually behave, on finding breast abnormality.Conclusions Strategies to improve early presentation and diagnosis with breast cancer among black women need to address symptom recognition and interpretation of risk, as well as fears of the consequences of cancer. The review is limited by the paucity of studies conducted outside the USA and limited detail reported by published studies preventing comparison between ethnic groups.https://bmjopen.bmj.com/content/4/2/e004076.full |
| spellingShingle | Ruth H Jack Jill Maben Elizabeth A Davies Emma Ream Grace Lucas Claire EL Jones Lindsay JL Forbes A systematic review of barriers to early presentation and diagnosis with breast cancer among black women BMJ Open |
| title | A systematic review of barriers to early presentation and diagnosis with breast cancer among black women |
| title_full | A systematic review of barriers to early presentation and diagnosis with breast cancer among black women |
| title_fullStr | A systematic review of barriers to early presentation and diagnosis with breast cancer among black women |
| title_full_unstemmed | A systematic review of barriers to early presentation and diagnosis with breast cancer among black women |
| title_short | A systematic review of barriers to early presentation and diagnosis with breast cancer among black women |
| title_sort | systematic review of barriers to early presentation and diagnosis with breast cancer among black women |
| url | https://bmjopen.bmj.com/content/4/2/e004076.full |
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