The purpose of this qualitative study (N = 98, 11 focus groups) is to investigate how low-income, African American and Hispanic older women make decisions about cervical cancer screening. Using the health belief model to guide content analysis of transcripts, we found that primary barriers to screening were; embarrassment with, fear of, and pain from the test, difficulty in accessing screening, stigma associated with Medicaid coverage, and prior negative experiences with cancer detection. Women experienced cues to screening from their own bodies, in symptoms, and relied on spiritual beliefs to support them in coping with their health problems. Enhanced understanding of these factors could increase uptake of cervical cancer screening among the unscreened and underscreened.

Background: The purpose of this study was to determine how acculturation affected awareness of genetic testing for cancer among Hispanic Americans. Methods: Subjects were 10,883 Hispanic respondents from the 2000 and 2005 National Health Interview Surveys. Acculturation was measured with language use and the length of time subjects had lived in the US. Weighted logistic regression was used to determine subjects’ awareness of genetic susceptibility testing. Results: Greater use of English (adjusted odds ratio, OR = 1.25, 95% confidence interval, CI = 1.15–1.36) was associated with increased awareness of genetic testing. Residence in the US for less than 5 years (adjusted OR = 0.55, 95% CI 0.36–0.83) was associated with lower awareness of testing. Conclusions: To better inform diverse American groups about genetic testing, intercultural variations and language skills must be taken into account.

OBJECTIVE To examine whether treatment with guideline-recommended care (surgery and chemotherapy) is associated with mortality differences between black and white women with advanced epithelial ovarian cancer. METHODS We conducted an observational cohort study using the Surveillance, Epidemiology, and End Results (SEER) linked to Medicare claims for 1995-2007. We evaluated long-term survival for 4,695 black and white women with stage III or IV epithelial ovarian cancer with Kaplan-Meier analysis and Cox regression, and then in patients matched by propensity score to create two similar cohorts for comparison. We investigated the association between race, stage, and survival among women who were treated with guideline-recommended care and those who received incomplete treatment. RESULTS Black women with advanced epithelial ovarian cancer were more likely to die than white women; unadjusted hazard ratio (HR):1.27 (95% confidence interval [CI]: 1.10-1.46). Black women were less likely than white women to receive guideline-recommended care (54% vs. 68%, p<0.001) and women who did not receive recommended treatment had lower survival than women who received recommended care. Cox proportional hazards models demonstrated no black versus white differences in mortality among women who were treated with guideline-recommended care; adjusted HR:1.04 (95% CI: 0.85-1.26) or among women who received incomplete treatment; adjusted HR:1.09 (95% CI: 0.89-1.34). The survival analysis of patients matched by propensity score confirmed these analyses. Conclusions Differences in rates of treatment with guideline-recommended care are associated with black–white mortality disparities among women with advanced epithelial ovarian cancer.