People in rural areas often have trouble getting access to healthcare. As part of testing a health education program in one North Carolina county, researchers looked at obstacles to breast cancer screening.

What the researchers wanted to know: What stops rural women from getting mammograms, and do black and American Indian women have more barriers to care than white women?

What they did: The researchers randomly chose women who were patients of one healthcare company in rural Robeson County, in southeastern North Carolina. "Minority" is a misnomer in this county—only a third of the residents are white, a quarter are black, and most of the rest are American Indians, mostly Lumbee. With the particular health provider they were sampling from, 60 percent were American Indians and nearly two thirds were below the poverty level. Anyway, the researchers picked out women who were over 40 and needed a mammogram—meaning they hadn't had one in a year. The 892 women were interviewed about education, income, health insurance, and cancer screening.

What they found: Many women said they had no time to get a mammogram or couldn't go to another place. Many also said they couldn't afford the test and either had no insurance or an insurer that didn't cover mammography; most of them didn't know about a cancer screening program that pays for mammograms for poor women. Three quarters of the women went to the doctor regularly, but two thirds said their doctors had never encouraged them to get mammograms. White women were more likely to know about the screening tests for breast cancer and cervical cancer and were also more likely to have graduated from high school and to have a higher socioeconomic status. Black women underestimated their risk of cancer more often than other women. Indian women knew the least about breast cancer and were the most worried about developing it.

What the study means to you: There do appear to be differences in the precise reasons that women of different racial groups don't get mammograms. This should help public health workers target their efforts to get women into mammography clinics.

Caveats: This is only one county in rural North Carolina; things could be different for poor, rural women in other parts of the country.

Find out more: www.lumbeetribe.com is the official website of the Lumbee tribe.

Read the article: Paskett, E.D. et al. "Racial Differences in Knowledge, Attitudes, and Cancer Screening Practices Among a Triracial Rural Population." Cancer. Dec. 1, 2004.

Abstract online: www3.interscience.wiley.com (published online Oct. 25, 2004)