How does social integration influence breast cancer control among urban African-American women? Results from a cross-sectional survey

Using data from 1997–1998 in-home interviews, we developed indices of six possible social roles, social networks of family, neighborhood and church, and instrumental and emotional social support. In multivariate models adjusting for age, education, and medical care, we examined the association of each social influence on breast cancer knowledge, attitudes, screening recency and intention, and treatment preferences.We found substantial variation in social integration among these women, with social integration positively associated with overall health and well-being. Social roles and networks were positively associated with screening knowledge, and emotional support and church networks were positively associated with attitudes conducive to early detection and treatment. In regard to screening behaviors, family networks were associated with both screening recency and intention. Women with greater church networks and emotional support held more conservative attitudes towards lumpectomy, reconstruction, and clinical trials.Overall, social integration is a positive influence on breast cancer control and should be utilized where possible in interventions, including identifying surrogate mechanisms for support for subgroups without existing social resources.There has been substantial success in reducing the societal level of burden from breast cancer in the United States over the past several decades. Although breast cancer incidence continues to grow, survival rates have also improved, an accomplishment attributed to multiple factors, including increased early detection, and improved treatment results among women diagnosed [1,2]. Despite improved survival rates among all groups, rates for African-American women still lag behind white women, due in part to less favorable disease characteristics, but also to lower rates of early detection and later stage at diagnosis [2-5].In order to reduce race-based breast cancer disparities, increasing mammography uptake and consistent u