title: Influence of health care, cost, and culture on breast cancer screening: issues facing urban American Indian women.
abstract: BACKGROUND
  Breast cancer is the second leading cause of cancer death among American Indian women. Southwestern American Indian women are more likely to have distant spread of the disease, and 5-year survival from breast cancer is poor in comparison to U.S. whites. Mortality from breast cancer could be reduced by more than 30% in American Indian women if current recommendations for screening were followed.
  
  
  METHODS
  A random household cross-sectional survey was conducted among 519 adult American Indian women in Phoenix, Arizona. Logistic regression was used to identify predictors of recent clinical breast examination and mammogram among those women aged 40 years and older.
  
  
  RESULTS
  Just more than half (53.0%) of the women surveyed reported they had received a clinical breast examination in the last year, and 35.7% indicated they had received a mammogram in the last 2 years. Access to care, knowledge of the examinations, and health beliefs were positively associated with breast cancer screening in the multivariate analyses.
  
  
  CONCLUSIONS
  The cancer screening rates observed in urban American Indian women are far below current national estimates and Healthy People 2000 Objectives. This study confirms the limited access of urban Indians to preventive health services, and supports a role for cancer education in improving screening participation in this special population.
authors.affiliation: Arizona Cancer Center, Tucson, Arizona 85724, USA.
authors.forename: B
authors.initials: B
authors.lastname: Risendal
authors.forename: D
authors.initials: D
authors.lastname: Roe
authors.forename: J
authors.initials: J
authors.lastname: DeZapien
authors.forename: M
authors.initials: M
authors.lastname: Papenfuss
authors.forename: A
authors.initials: A
authors.lastname: Giuliano
mesh_terms: D000328:Adult; D000368:Aged; D001130:Arizona / Q000453:epidemiology; D001943:Breast Neoplasms / Q000208:ethnology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007198:Indians, North American / Q000523:psychology / Q000706:statistics & numerical data*; D016015:Logistic Models; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012959:Socioeconomic Factors