Health Literacy Stands in the Way of Adequate Breast Cancer Screening

Fewer than half of adults are aware of the common signs of breast cancer, save for having a lump, a clear signal that patient health literacy is faltering, researchers from The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) said in a recent report.

“We want people to feel empowered about their bodies and know what is normal for them. Many breast changes are the result of aging and childbirth; however, breast cancer can present in a number of ways,” Ashley Pariser, MD, a breast medical oncologist and director of brest cancer survivorship at OSUCCC – James, said in a statement. “It is important that people feel safe to address these concerns in a timely way with their doctor. We have made great strides in detecting breast cancers in far earlier, more treatable stages.” 

Although 93 percent of adults are aware that a lump is a key warning sign of breast cancer, far fewer know about the lesser-known symptoms, including:

• retracted, inverted, or downward-pointing nipple (31 percent)
• breast puckering (an indentation that appears when you raise your arms) (39 percent)
• loss of feeling in part of the breast (41 percent)
• pitting/thickening of the skin on the breast (45 percent)
• nipple discharge (51 percent)

“Screening mammography is our No. 1 defense in detecting and addressing breast cancers at their earliest, most treatable stages, but it is also very important for people to be familiar with the look and feel of their own breast tissue so that sometimes subtle changes can be evaluated quickly to give us the best chance at early detection,” Pariser explained.

These findings come as the US continues to stare down cancer screening gaps. February 2023 data showed that cancer screening rates tanked during the pandemic. The good news is cancer diagnoses didn’t rise during this time, but healthcare providers still continue to work toward closing them.

This latest survey highlights not just the care access barriers but also the patient health literacy and education hurdles standing in the way of adequate breast cancer screening.

In addition to limited health literacy about the key symptoms and warning signs of breast cancer, the OSUCCC – James survey showed a limited understanding of the best types of breast cancer screening.

Screening mammography is the best method for breast cancer screening, but patients aren’t always sure when to access it. This is especially salient for younger patients under age 30, 44 percent of whom reported they are confused about the best strategy for breast cancer screening.

“The best way for us to find breast cancer early is for women to present as soon as they notice a change, ideally even before they see a change. So that’s why we recommend screening mammograms for those who qualify if we want to find breast cancer early,” said Pariser, who also is an assistant professor in the College of Medicine and an affiliate member of the Cancer Control Program at the OSUCCC – James.

The United States Preventive Services Task Force (USPSTF) recommends that all women get screened for breast cancer every other year starting at age 40. According to Pariser, people with dense breast tissue, Black people, and Ashkenazi Jewish people should consider more intensive screening due to higher risk.

Importantly, it’ll be essential for healthcare providers to be realistic with patients about breast cancer. The OSUCCC – James survey showed that three-quarters of female survey respondents said they don’t believe they’ll ever great breast cancer. For men, that figure was 91 percent.

“So, although we are making great strides in terms of detection and treatment, unfortunately we live in a world where breast cancer is still a serious concern for people,” Pariser concluded. “Although the disease is less common in men, 1% of breast cancers occur in men. These cancers typically present as nipple changes, so it is also important that men feel empowered to seek medical attention for concerning symptoms, especially if they have a strong family history of breast cancer.”