Nursing professors Bonnie Jerome-D’Emilia, left, and Sheila Linz.
By Jeanne Leong
Some women cite lack of insurance and access to preventive care and the fear of pain from a mammogram as reasons why they do not get breast cancer screenings. The barriers are even steeper for women with mental health conditions, as two Rutgers University‒Camden researchers are finding in their research.
“Getting a mammogram is not a priority because they’re more focused on getting help for their psychological symptoms,” says Bonnie Jerome-D’Emilia, an associate professor of nursing. “They’re focused on having a place to live and food to eat, so planning ahead to get a screening because they might in the future get breast cancer is not necessarily on their mind.”
The study, funded by the Rutgers Community Design for Health and Wellness Interdisciplinary Research Group, enabled principal investigator Sheila Linz and Jerome-D’Emilia to collaborate with Jewish Family Service of Atlantic and Cape May Counties. The Rutgers School of Nursing‒Camden colleagues, along with a community advisory board, are working to provide health education and encourage women to receive screenings to help reduce the risk of developing breast cancer.
Breast cancer is the second most common cancer among women in the United States, and nearly one-third do not have regular breast cancer screenings, according to the Centers for Disease Control and Prevention (CDC).
“Women with severe mental illness are 30% less likely to get mammography screening,” says Linz, an assistant professor of nursing at Rutgers–Camden and a psychiatric nurse practitioner. “The delay in care makes the prognosis worse.”
When Jerome-D’Emilia and Linz began the study earlier this year, they planned to conduct in-person interviews, but because of the pandemic, they switched to phone interviews.
In conversations with more than a dozen South Jersey women diagnosed with a mental health condition, Jerome-D’Emilia and Linz are learning how to help women with these conditions feel more comfortable about getting a mammogram.
Many of the women are diagnosed with anxiety, says Linz, and the idea of going out of the house to get a mammogram can be very stressful. “The ability to keep appointments is difficult, because you don’t know how you’ll feel on the day of your appointment,” Linz explains. “You may not be able to get out of bed on the day of your appointment, or you may be feeling extremely anxious. Having a test like this does increase anxiety in most of the women we’ve spoken to.”
One woman shared details of an incident in her childhood that made her feel uncomfortable getting a physical exam. Some said they prefer to have a woman health care provider. Others talked about difficult issues in their personal lives, revealing why health care is not a priority for them.
“They are really reaching down to help elucidate this particular issue,” says Linz. “They value that someone is asking them. They aren’t treated with respect very often and they rise to the occasion when they do. They are trying to come up with solutions within the chaos of their lives.”
The women suggested how to reach others with mental health conditions, including asking health care providers to provide appointment reminders by phone, text, or email, and having mental health providers talk to women about getting breast cancer screening.
The Rutgers‒Camden scholars plan to write an article about their research and develop a podcast, describing the breast cancer screening model used at this Jewish Family Service agency and serve as a model for other community agencies in New Jersey.
Jerome-D’Emilia, an expert in racial and socioeconomic disparities in access to cancer care, has studied women’s decision-making in breast cancer screening in low-income African American and Hispanic communities.
Linz has worked on outreach teams, shelters for mental health patients, community clinics, and nurse-run mental health clinics, and has studied issues that affect individuals with severe mental health conditions.
“It has worked well for us because we are able to put each of our areas of expertise together in the study,” says Jerome-D’Emilia.
The researchers are also conducting a study of women with mental health conditions who are diagnosed with breast cancer. Linz and D’Emilia are finding that these women are more difficult to locate.
“A lot of these women are homeless, they may be using substances, they may have severe symptoms,” says Linz. “Once they are screened, there’s a problem getting them to follow up for treatment. It’s important to know, once they’ve been diagnosed, what happens next?”