An Innovative Community-Based Intervention for African American Women with Breast Cancer: The Witness Project®

Overall, the incidence rates of breast cancer among women have continually increased since 1980 (American Cancer Society [ACS], 2005). Despite advances made in the prevention, diagnosis, and treatment of breast cancer over the past several decades, there continues to be a major disparity in breast cancer morbidity and mortality between African American and white women. ACS estimated that 211,240 U.S. women would be diagnosed with breast cancer in 2005 and 40,410 would die from the disease. African American women have a lower incidence of breast cancer than white American women (119.9 per 100,000 compared with 141.7 per 100,000), but a higher mortality rate (35.4 per 100,000 compared with 26.4 per 100,000) (ACS). There are a variety of reasons postulated to explain the lower incidence yet higher mortality rate of breast cancer in African American women, including less access to health care, lack of health insurance, lower socioeconomic status, communication barriers, and perceptions among this population that cancer is fatal (Paskett et al., 2004; Schwartz, Crossley-May, Vigneau, Brown, & Banerjee, 2003; Smedley, Stith, & Nelson, 2003). BREAST CANCER OUTREACH TO THE AFRICAN AMERICAN COMMUNITY: THE WITNESS PROJECT[R] The focus of outreach to combat mortality from breast cancer in African American women has been to develop culturally relevant and spiritually based programs aimed at dispelling many of the barriers to screening, diagnosis, and treatment held by African American women regarding cancer (Altpeter, Earp, Bishop, & Eng, 1999). Breast cancer is not a subject openly discussed among many in the African American community (Personal communication from K. Cuthbert, African American breast cancer survivor, U.S. Army, October 5, 2003) and many believe that treatment is not effective in saving lives (Phillips, 1999). Many African Americans view breast cancer as inevitably fatal and believe that there is little value in detecting the disease early. Long (1993) identified interventions noted "to be effective in empowering poor and African-American women to combat the fear and fatalism associated with a diagnosis of breast cancer" (p. 10) including community organization and coalition, health education and community outreach programs, client education to motivate desired behavior by framing the message in terms of gains or losses, among others. African American women use a combination of informal and formal supports to cope with their breast cancer (Henderson & Fogel, 2003). The Witness Project[R] (WP) was started in 1991 at the University of Arkansas Medical Science Center as a response to the high mortality rate of African American women with breast cancer living in Arkansas. This innovative project was designed to reach out to low-income and rural African American women in a way that was culturally relevant to increase awareness and participation in breast cancer screening (Erwin, Spatz, Stotts, Hollenberg, & Deloney, 1996). A community-based cancer screening program of proven effectiveness, the WP is grounded in the deep spiritual roots of African American women and uses affirmation to increase women's belief in their ability to seek action to save their lives. Breast cancer survivors, referred to as Witness Role Models, tell their breast cancer story--from detection through treatment--using the spiritual method of "witnessing," in which a person shares a personal religious experience with the congregation and testifies by explaining how this experience changed her life (Erwin, Spatz, & Turturro, 1992). Survivors are paired with a Lay Health Advisor who teaches breast self-exams (BSE) and talks about mammography and the role it plays in early detection. Erwin, Spatz, and colleagues (1996) suggested that the behavior of WP participants changes "because the messages are crafted to meet the women's beliefs ... [by] the witness role models present[ing] their stories within a framework that honors culture and local health beliefs" (p. …