come, or education, although some regional differences exist. Mammography use is higher among women who understand the purpose of mammography, especially its value in the absence of symptoms, and the recommended age-based intervals (McDonald et al., 1999; Lee et al., 1999; Maxwell, Bastani, and Warda, 1997, 1998a, 1998b; Wismer et al., 1998; Fernandez, Tortolero-Luna, and Gold, 1998; Rimer, 1994). This is true across populations, including African-American and Hispanic women (e.g., Valdez et al., 2001). Older women who recognize that age is the most important risk factor for breast cancer and that older women are more likely to get breast cancer are more likely to report having had mammograms (Fox, Murata, and Stein, 1991; Fox, Roetzheim, and Kington, 1997). Similarly, physician knowledge of screening recommendations is an important predictor of physician practices, although this factor has received less attention in the literature (Fox, Roetzheim, and Kington, 1997).

A recent report indicated that Hispanic women were more likely than non-Hispanic women to agree with the statement that once you get cancer you will always die from it (Puschel et al., 2001). Health providers reported that Hispanic women were more likely than non-Hispanic women to resist breast exams, which providers ascribed to women’s fears of anything that might threaten their integrity as women (Puschel et al., 2001). Other studies have shown that older Hispanic women know less about breast cancer screening than other women (Puschel et al., 2001; Calle et al., 1993; Lantz et al., 1994; Stein and Fox, 1990; Fox et al., 1998). Most recently, Valdez et al. (2001) showed that Hispanic women who were more fearful were less likely to have had recent mammograms. In general, the low levels of knowledge about cancer screening among Hispanic women are more likely to be accounted for by socioeconomic factors, such as low education and low income, than by acculturation, language, or ethnicity (Zambrana et al., 1999; Schur, Leigh, and Berk, 1995; Fox and Roetzheim, 1994). Indeed, language is not a major barrier to screening if health care is accessible (Zambrana et al., 1999).



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