Breast Health Education Among Hispanic Elderly Women

Older women are at higher risk of developing breast cancer and dying from the disease than their younger counterparts. Despite the use of mammography and clinical breast examination (CBE) as best practices for early detection of breast cancer, women 50 years of age and older have been slow in adopting these practices. Research has shown that older women are not generally aware that they are vulnerable to a greater risk of breast cancer or that mammograms are needed even in the absence of symptoms. Moreover, Hispanic women's knowledge about breast cancer and use of CBE and mammography are lower than that of their White and African American counterparts.

The intervention is a culturally sensitive health promotion pilot program, developed to promote the early detection of breast cancer in women aged 65 or older living in Puerto Rico. The goal of the program is to increase compliance with the recommended guidelines for breast cancer screening.  Objectives to reach this goal include the following: (1) minimizing barriers that might prevent older women from undergoing breast cancer screening as well as increasing awareness of breast cancer and the importance of breast cancer screening for early detection of the disease; (2) teaching skills related to breast self-examination; and (3) motivating older women to communicate assertively with their physicians about breast cancer and breast cancer screening practices.

The program consists of: (1) a culturally appropriate health education program for women 65 years or older on breast cancer and early detection practices; (2) training for primary care health professionals on breast cancer screening current guidelines for women 65 or older and barriers that affect compliance; and (3) the coordination of support services to facilitate access to CBEs and mammography services, including coordination of medical appointments among health care providers, sending appointment reminders, and providing transportation to the CBEs and mammograms. 

The health education program is designed to be held in three 45- to 60-minute sessions. In addition, a 1-day training session can be provided for primary care health professionals with patients aged 65 years and older. 

The intended audience for this intervention is women aged 65 or older living in Puerto Rico who have not had mammograms or CBEs in accordance with current guidelines for breast cancer early detection practices.

This program is suitable for implementation at senior centers and in primary health care settings targeting elderly people.

The manual entitled "Programa Educativo para la Deteccion del Cancer de Mama en las Mujeres de Edad Mayor en Puerto Rico: Manual para las Facilitadoras" is required to implement this program. This manual is only available in Spanish. 

Participants in the pilot program were selected from women receiving services at senior centers in Puerto Rico that offer services to the low-income elderly population. Thirty-two women who met study inclusion criteria were selected to participate. The participants had an average age of 78.1 years (+ 7.4 years) and were generally of low educational attainment (4.9 + 4.9 years).  All women received the health education sessions. One group (n=20) then received external support services to facilitate access to CBEs and mammography services. These services included coordination of medical appointments, reminders two days before the appointments, and transportation to CBE and mammograms. The other group (n=12) did not receive any type of external support, although participants were strongly encouraged during the sessions to seek breast cancer screening tests. 

Breast cancer knowledge and beliefs were measured using true/false statements administered before and after the health education sessions. A higher score on the knowledge scale indicated greater breast cancer knowledge, and a higher score on the beliefs scale indicated fewer notions not based on scientific facts.  Participants' self-report of breast cancer early detection practices (i.e., having received a CBE in the past year and a mammogram within the past 2 years) were obtained before the health education sessions and 16-18 weeks after the end of the health education sessions. For changes in knowledge and beliefs, pre-session scores were compared to post-session scores for all 32 participants. For the long-term evaluation of compliance with CBE and mammography recommendations, 16- to 18-week followup scores for the external support group were compared to scores for the group that did not receive external support. 

• All of the participants who received external support services in addition to the health education sessions self-reported compliance with CBE recommendations 16 to 18 weeks after the end of the health education sessions, compared to 20% of participants who received only the health education sessions (p<.05). 

• Among women who had not had a mammogram prior to the educational sessions, all of the women in the group receiving external support had the test performed within the 16-18 weeks following the end of the health education sessions, compared to none of the women who did not receive external support (p<.05).

• Participants showed a significant increase in breast cancer beliefs (p=.0029) and knowledge (p=.0192) after the educational sessions.