Breast cancer screening through annual mammography and breast physical examinations is highly successful in diagnosing early onset of the disease and improving survival rates among women over 50. However, among ethnic minority groups such as African American women, particularly in rural areas, there are barriers to participation in these screening activities. For African American women, particularly in rural areas, these include economic barriers, problems with transportation, access-related factors, inconvenience and lack of time, lack of physician recommendation, psychological factors such as fear and fatalism, lack of knowledge and awareness of breast cancer, and misunderstanding of recommended screening frequency. Factors such as these contribute to African American women's higher rates of mortality in all stages of breast cancer, despite the fact that they have a somewhat lower incident rate of breast cancer overall. The Witness Project is a theory-based program designed specifically for African Americans to increase awareness and screening for breast cancer. This program has been implemented in many states across the country.
Note: While breast self examination (BSE) has not been shown to be an effective early detection method, BSE training and processes are used in the educational program and agenda of the Witness Project as a behavior change modifier that has been shown to lead African American women to: 1) be more comfortable with their bodies and pay more attention to changes that might occur and 2) be more likely to decide to obtain clinical breast examinations (CBE) and mammograms. (Bloom JR, Grazier K, Hodge F, Hayes WA: Factors affecting the use of screening mammography among African-American women. Cancer Epidemiology Biomarkers and Prevention 1:75-82, 1991)