Science Spotlight

Ethnicity differences in response to receiving abnormal mammogram results

picture of author
Lead author Dr. Yamile Molina, a fellow in the Biobehavioral Cancer Prevention and Control training program.

Image provided by Dr. Yamile Molina.
Breast cancer is a leading cause of death for women in the United States.  While mammography is an important tool for early detection and treatment, receiving an abnormal mammogram result can lead to negative psychosocial consequences.  Negative psychological consequences may in turn influence subsequent screening decisions among women not diagnosed with breast cancer, as well as influence mental health outcomes for women diagnosed with breast cancer. Despite having a lower incidence of breast cancer compared to non-Latina Caucasian women, Latinas are more likely to be diagnosed at later stages, have worse prognoses, lower survival, and experience poorer mental health outcomes.  While previous research has explored potential reasons for these disparities, less explored is whether there are ethnic differences in mental health comorbidities after an abnormal screening result.  In a recent report in Oncology Nursing Forum, Drs. Yamile Molina, Shirley A.A. Beresford, and Beti Thompson in the Public Health Sciences Division found that Latinas and non-Latina Caucasians differ in their response to an abnormal mammography result.  Overall, Latinas experienced greater psychological distress and social withdrawal compared to non-Latina Caucasians.

"Receiving an abnormal cancer screening result is stressful," said lead author Dr. Molina.  Understanding the impact of the psychological distress caused by an abnormal mammography result is important because it can impact short-term and long-term consequences related to early detection, follow-up, treatment adherence, and support.  Said Molina, "ethnic disparities in distress are important to consider, as previous work has indicated elevated psychological distress after an abnormal result to influence women’s decisions to obtain recommended care and their mental health.   Ethnic differences in social withdrawal are also important, as greater social isolation may reduce Latinas’ access to culturally salient resources, such as their family and friends."
Coping can be thought of as the mediator between stressful situations and the emotional response to those stressors.  While previous research on ethnic differences in breast cancer have focused on coping in response to treatment and survivorship, ethnic differences in coping following an abnormal mammogram may influence mental health and consequently diagnostic delays. Said Molina, "this work was a first step to understanding if and why there may be ethnic differences in how women feel when they are told about an abnormal screening result."

To assess these potential differences in coping, the authors interviewed 82 women in urban areas of Seattle and Yakima about their responses to receiving abnormal mammography results.  Validated psychological survey instruments provided quantitative measurements of psychological distress, coping behaviors, and social withdrawal, which could then be compared between Latinas and non-Latina Caucasians.  From these analyses, said Molina, "our team found that Latinas experience greater psychological distress and more social withdrawal after receiving an abnormal result compared to White women."

The authors also conducted modeled whether ethnic differences in coping might underlie ethnic differences in mental health outcomes.  "Our work suggests that coping strategies may underlie the differences in mental health outcomes," said Molina.  "Latinas employ greater amounts of denial coping in response to receipt of an abnormal mammogram result, which appears to lead to greater psychological distress. Further, they are more likely to use religious coping, which appears to result in greater social withdrawal."  These results are similar to previous studies finding ethnic differences in coping among cancer patients and survivors, and are important "as they suggest Latinas may be a particularly vulnerable group for adverse mental health outcomes across the breast cancer continuum," said Molina.

While results of this pilot study require further study, these findings could help inform future interventions and programs dedicated to improving the well-being of traditionally underserved and vulnerable populations such as Latinas.  Moving forward, said Molina, "our team has conducted some recent analyses indicating that Latinas experience elevated distress even months after a definitive non-cancer diagnosis.  Greater psychological distress among Latinas may underlie the lower rates of repeat mammography in this population.  Our work points to the need for larger-scaled studies to confirm these associations and the effect of elevated distress and social withdrawal on subsequent adherence to care for Latinas."

Molina Y, Beresford SA, Espinoza N, Thompson B. 2014. Psychological distress, social withdrawal, and coping following receipt of an abnormal mammogram among different ethnicities: a mediation model. Oncol Nurs Forum. 41(5):523-32.