Supportive Care in Cancer

, Volume 24, Issue 7, pp 3077–3084 | Cite as

Medical advocacy among African-American women diagnosed with breast cancer: from recipient to resource

  • Yamile MolinaEmail author
  • Ashley Scherman
  • Tara Hayes Constant
  • Bridgette Hempstead
  • Jacci Thompson-Dodd
  • Shayla Richardson
  • Shauna Rae Weatherby
  • Kerryn W. Reding
  • Rachel M. Ceballos
Original Article



Medical advocacy at multiple levels (self, community/interpersonal, national/public health interest) may be helpful to address the disproportionate burden of breast cancer African-American women encounter. Little, however, is known about the interplay of medical advocacy at different levels.


We analyzed qualitative data from two studies focused on the psychosocial experiences of breast cancer among 38 African-American women living in Western Washington State.


Emergent themes suggested that survivors received community/interpersonal advocacy from different members of social networks in the form of social support (appraisal, emotional, informational, instrumental). Survivors indicated that receiving this support was associated with greater self-advocacy in terms of their own care experiences, as well as greater community/interpersonal advocacy on their part as resources to other women diagnosed with breast cancer, their family, friends, and larger communities.


Our findings suggest that community/interpersonal advocacy, including providing different types of support, may lead to improved self-advocacy as well as health-protective impacts for the networks in which survivors are embedded. Future quantitative research is warranted to support these findings and assess how this interplay is associated with improved outcomes among this marginalized and resilient population.


Breast cancer disparities African-American Cancer survivor Medical advocacy 



The authors would like to thank study participants for their time, effort, and perspectives. For their assistance with data collection, we thank expert interviewers Edree Allen-Agbro and Arthur Walker. This work was supported by the National Cancer Institute under grant numbers U54CA202997, R25CA92408 and K01CA154938-01A1 and the Puget Sound Affiliate of Susan G. Komen. YM was also supported by the University of Illinois Cancer Center and Center for Research on Women and Gender. The opinions or assertions contained herein are the private ones of the authors and are not considered as official or reflecting the views of the National Institutes of Health or Susan G. Komen.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.


  1. 1.
    Ooi SL, Martinez ME, Li CI (2011) Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Res Treat 127:729–738CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Field TS, Buist D, Doubeni C, Enger S, Fouayzi H, Hart G, Korner EJ, Lamerato L, Bachman DJ, Ellis J (2004) Disparities and survival among breast cancer patients. J Natl Cancer Inst Monogr 35:88–95Google Scholar
  3. 3.
    Ademuyiwa FO, Edge SB, Erwin DO, Orom H, Ambrosone CB, Underwood W (2011) Breast cancer racial disparities: unanswered questions. Cancer Res 71:640–644CrossRefPubMedGoogle Scholar
  4. 4.
    Fedewa SA, Ward EM, Stewart AK, Edge SB (2010) Delays in adjuvant chemotherapy treatment among patients with breast cancer are more likely in African American and Hispanic populations: a national cohort study 2004–2006. J Clin Oncol 28:4135–4144CrossRefPubMedGoogle Scholar
  5. 5.
    Wheeler SB, Reeder-Hayes KE, Carey LA (2013) Disparities in breast cancer treatment and outcomes: biological, social and health system determinants and opportunities for research. Oncologist 18:986–993CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Rizzo M, Lund MJ, Mosunjac M, Bumpers H, Holmes L, O’Regan R, Brawley OW, Gabram S (2009) Characteristics and treatment modalities for African American women diagnosed with stage III breast cancer. Cancer 115:3009–3015CrossRefPubMedGoogle Scholar
  7. 7.
    Gerend MA, Pai M (2008) Social determinants of Black-White disparities in breast cancer mortality: a review. Cancer Epidemiol Biomarkers Prev 17:2913–2923CrossRefPubMedGoogle Scholar
  8. 8.
    Blackman DJ, Masi CM (2006) Racial and ethnic disparities in breast cancer mortality: are we doing enough to address the root causes? J Clin Oncol 24:2170–2178CrossRefPubMedGoogle Scholar
  9. 9.
    Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, Karaca G, Troester MA, Tse CK, Edmiston S, Deming SL (2006) Race, breast cancer subtypes and survival in the Carolina Breast Cancer Study. JAMA 259:2492–2502CrossRefGoogle Scholar
  10. 10.
    Molina Y, Silva A, Rauscher GH (2015) Racial/ethnic disparities in time to a breast cancer diagnosis: the mediating effects of health care facility factors. Med Care 53:872–878CrossRefPubMedGoogle Scholar
  11. 11.
    Silber JH, Rosenbaum PR, Clark AS, Giantonio BJ, Ross RN, Teng Y, Wang W, Even-Shoshan O (2013) Characteristics associated with differences in survival among black and white women with breast cancer. JAMA 310:389–397CrossRefPubMedGoogle Scholar
  12. 12.
    Zapka JM, Edwards HM, Chollette V, Taplin SH (2014) Follow-up to abnormal cancer screening tests: considering the multilevel context of care. Cancer Epidemiol Biomarkers Prev 23:1965–1973CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Cooper LA, Ortega AN, Ammerman AS, Buchwald D, Paskett ED, Powell LH, Thompson B, Tucker KL, Warnecke RB, McCarthy WJ (2015) Calling for a bold new vision of health disparities intervention research. Am J Public Health 105:S374–S376CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Ashing KT, Miller AM, Mitchell E, Martin V, McDowell K, Santifer RH, Smith J, Brown S, Ragin C, Carrington A (2014) Nurturing advocacy inclusion to bring health equity in breast cancer among African-American women. Breast Cancer Manag 3:487–495CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hagan TL, Donovan HS (2013) Ovarian cancer survivors’ experiences of self-advocacy: a focus group study. Oncol Nurs Forum 40:140–147CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Molina Y, Hempstead BH, Thompson-Dodd J, Weatherby SR, Dunbar C, Hohl SD, Malen RC, Ceballos RM (2014) Medical advocacy and supportive environments for African-Americans following abnormal mammograms. J Cancer Ed 30:447–452CrossRefGoogle Scholar
  17. 17.
    Wiltshire J, Cronin K, Sarto GE, Brown R (2006) Self-advocacy during the medical encounter: use of health information and racial/ethnic differences. Med Care 44:100–109CrossRefPubMedGoogle Scholar
  18. 18.
    Allen JD, Shelton RC, Harden E, Goldman RE (2008) Follow-up of abnormal screening mammograms among low-income ethnically diverse women: findings from a qualitative study. Patient Educ Couns 72:283–292CrossRefPubMedGoogle Scholar
  19. 19.
    Kerner JF, Yedidia M, Padgett D, Muth B, Washington KS, Tefft M, Yabroff KR, Makariou E, Freeman H, Mandelblatt JS (2003) Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black women. Prev Med 37:92–101CrossRefPubMedGoogle Scholar
  20. 20.
    Molina Y, Kim S, Berrios N, Calhoun EA (2014) Medical mistrust and patient satisfaction with mammography: the mediating effects of perceived self-efficacy among navigated African American women. Health Expect 18:2941–2950CrossRefPubMedGoogle Scholar
  21. 21.
    Maly RC, Stein JA, Umezawa Y, Leake B, Anglin MD (2008) Racial/ethnic differences in breast cancer outcomes among older patients: effects of physician communication and patient empowerment. Health Psychol 27:728CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Stajkovic AD, Luthans F (1998) Social cognitive theory and self-efficacy: going beyond traditional motivational and behavioral approaches. Organ Dyn 26:62–74CrossRefGoogle Scholar
  23. 23.
    McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K, Wagner EH (2011) Self-management: enabling and empowering patients living with cancer as a chronic illness. CA-Cancer J Clin 61:50–62CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Helgeson VS, Cohen S (1996) Social support and adjustment to cancer: reconciling descriptive, correlational, and intervention research. Health Psychol 15:135–148CrossRefPubMedGoogle Scholar
  25. 25.
    Kroenke CH, Kubzansky LD, Schernhammer ES, Holmes MD, Kawachi I (2006) Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol 24:1105–1111CrossRefPubMedGoogle Scholar
  26. 26.
    Benkert R, Hollie B, Nordstrom CK, Wickson B, Bins-Emerick L (2009) Trust, mistrust, racial identity and patient satisfaction in urban African American primary care patients of nurse practitioners. J Nurs Sch 41:211–219CrossRefGoogle Scholar
  27. 27.
    Bradley PK (2006) Breast cancer in African American women. In: Collins CF (ed) African American women’s health and social issues. Praeger, Westport, pp. 36–45Google Scholar
  28. 28.
    Mathews HF (2009) Cancer support groups and health advocacy: one size doesn’t fit all. In: McMullin J, Weiner D (eds) Confronting cancer: metaphors, inequality, and advocacy. School of American Research, Sante Fe, pp. 43–86Google Scholar
  29. 29.
    Almog-Bar M, Schmid H (2013) Advocacy activities of nonprofit human service organizations: a critical review. Nonprof Vol Volunt Sec Q 43:11–35CrossRefGoogle Scholar
  30. 30.
    Sheppard VB, Wallington SF, Willey SC, Hampton RM, Lucas W, Jennings Y, Horton S, Muzeck N, Cocilovo C, Isaacs C (2013) A peer-led decision support intervention improves decision outcomes in black women with breast cancer. J Cancer Ed 28:262–269CrossRefGoogle Scholar
  31. 31.
    Giese-Davis J, Bliss-Isberg C, Carson K, Star P, Donaghy J, Cordova MJ, Stevens N, Wittenberg L, Batten C, Spiegel D (2006) The effect of peer counseling on quality of life following diagnosis of breast cancer: an observational study. Psycho-Oncol 15:1014–1022CrossRefGoogle Scholar
  32. 32.
    McQueen A, Kreuter MW, Kalesan B, Alcaraz KI (2011) Understanding narrative effects: the impact of breast cancer survivor stories on message processing, attitudes, and beliefs among African American women. Health Psychol 30(6):674–682CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    King S (2004) Pink Ribbons Inc: breast cancer activism and the politics of philanthropy. Int J QUal Stud Ed 17:473–492CrossRefGoogle Scholar
  34. 34.
    Wells AA, Gulbas L, Sanders-Thompson V, Shon E-J, Kreuter MW (2014) African-American breast cancer survivors participating in a breast cancer support group: translating research into practice. J Cancer Ed 29:619–625CrossRefGoogle Scholar
  35. 35.
    Smith YR, Johnson AM, Newman LA, Greene A, Johnson TR, Rogers JL (2007) Perceptions of clinical research participation among African American women. J Women Health 16:423–428CrossRefGoogle Scholar
  36. 36.
    Bernard HR, Ryan GW (2009) Analyzing qualitative data: systematic approaches. SAGE Publications, Los AngelesGoogle Scholar
  37. 37.
    Hsieh H-F, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15:1277–1288CrossRefPubMedGoogle Scholar
  38. 38.
    US Department of Health and Human Services (2013) Centers For Disease Control And Prevention, Behavioral Risk Factor Surveillance System Survey (BRFSS) Data. Accessed 5 Jan 2016
  39. 39.
    US Department of Health and Human Services (1995-2012) National Cancer Institute, Cancer Incidence – Surveillance, Epidemiology, and End Results (SEER) Registries Research Data. Accessed 5 Jan 2016
  40. 40.
    Newsom JT, Rook KS, Nishishiba M, Sorkin DH, Mahan TL (2005) Understanding the relative importance of positive and negative social exchanges: examining specific domains and appraisals. J Gerontol B Psychol Sci Soc Sci 60:P304–P312CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Suri H (2011) Purposeful sampling in qualitative research synthesis. Qual Res J 11:63–75CrossRefGoogle Scholar
  42. 42.
    Sandelowski M, Barroso J (2003) Classifying the findings in qualitative studies. Qual Health Res 13:905–923CrossRefPubMedGoogle Scholar
  43. 43.
    Sandelowski M (2001) Real qualitative researchers do not count: the use of numbers in qualitative research. Res Nurs Health 24:230–240CrossRefPubMedGoogle Scholar
  44. 44.
    Catalani C, Minkler M (2010) Photovoice: a review of the literature in health and public health. Health Ed Behav 37:424–451CrossRefGoogle Scholar
  45. 45.
    Burgess J (2006) Hearing ordinary voices: cultural studies, vernacular creativity and digital storytelling. Continuum J Media Cult Stud 20:201–214CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Yamile Molina
    • 1
    • 2
    Email author
  • Ashley Scherman
    • 2
    • 3
  • Tara Hayes Constant
    • 2
    • 3
  • Bridgette Hempstead
    • 4
  • Jacci Thompson-Dodd
    • 5
  • Shayla Richardson
    • 4
  • Shauna Rae Weatherby
    • 6
  • Kerryn W. Reding
    • 2
    • 3
  • Rachel M. Ceballos
    • 2
    • 3
  1. 1.University of Illinois-ChicagoChicagoUSA
  2. 2.Fred Hutchinson Cancer Research CenterSeattleUSA
  3. 3.University of WashingtonSeattleUSA
  4. 4.Cierra SistersSeattleUSA
  5. 5.WeSpeakLoudlySeattleUSA
  6. 6.MultiCare Health SystemTacomaUSA

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