Although patterns of African American and white women breast cancer incidence and mortality in St. Louis, Missouri is consistent with those seen elsewhere in the United States, rates vary greatly across zip codes within the city of St. Louis. North St. Louis, whose neighborhoods are primarily African American, exhibits rates of breast cancer mortality that are among the highest in the city and higher than the state as a whole. Based on information that up to 50% of women in North St. Louis with a suspicious diagnosis of breast cancer never enter treatment, we conducted three 2-hour group model building sessions with 34 community stakeholders (e.g., breast cancer survivors or family members or caregivers and community support members such as navigators) to identify the reasons why African American women do not begin or delay breast cancer treatment. Participant sessions produced a very rich and dynamic causal loop diagram of the system producing disparities in breast cancer mortality in St. Louis. The diagram includes 8 major subsystems, causal links between system factors, and feedback loops, all of which shed light on treatment delays/initiation. Our work suggests that numerous intersecting factors contribute to not seeking treatment, which in turn may contribute to African American and white disparities in mortality.

Although patterns of African American and white women breast cancer incidence and mortality in St. Louis, Missouri is consistent with those seen elsewhere in the United States, rates vary greatly across zip codes within the city of St. Louis. North St. Louis, whose neighborhoods are primarily African American, exhibits rates of breast cancer mortality that are among the highest in the city and higher than the state as a whole. Based on information that up to 50% of women in North St. Louis with a suspicious diagnosis of breast cancer never enter treatment, we conducted three 2-hour group model building sessions with 34 community stakeholders (e.g., breast cancer survivors or family members or caregivers and community support members such as navigators) to identify the reasons why African American women do not begin or delay breast cancer treatment. Participant sessions produced a very rich and dynamic causal loop diagram of the system producing disparities in breast cancer mortality in St. Louis. The diagram includes 8 major subsystems, causal links between system factors, and feedback loops, all of which shed light on treatment delays/initiation. Our work suggests that numerous intersecting factors contribute to not seeking treatment, which in turn may contribute to African American and white disparities in mortality.

Breast cancer is a serious illness that often has fatal consequences. Adherence to the recommendations for breast cancer surveillance is poorly practiced among African American women. The purpose of this phenomenological study was to seek individual professed barriers to breast cancer screening among African American women to better understand why breast cancer continues to be one of the principal basis of mortality among African American women. The theoretical framework for this study was the behavioral model of health services use. Purposeful selection was used to invite 14 African American women to participate in the in-depth interview process. Interview data were transcribed and then coded for recurring themes and meaning. The findings of this study demonstrate that these women's perceived barriers to breast cancer screening were lack of information, a belief that genetics dictates who gets breast cancer, embarrassment, a norm of people not going for health checkups, the procedure of breast cancer screening, and fear. Participants noted that the improved method of mammography may promote utilization within the population. Breast cancer disparities among African American women may decline if healthcare providers promote awareness of the availability and accessibility of breast cancer prevention resources and if African American women understand the barriers to breast cancer prevention and change their own screening practices.