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J Womens Health (Larchmt). 2018 Nov 27. doi: 10.1089/jwh.2018.7031. [Epub ahead of print]

Effect of Cultural, Folk, and Religious Beliefs and Practices on Delays in Diagnosis of Ovarian Cancer in African American Women.

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1 Department of Community and Family Medicine, Duke Cancer Institute, Duke University , Durham, North Carolina.
2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.
3 Department of Population Science, Rutgers Cancer Institute of New Jersey , New Brunswick, New Jersey.
4 Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine , Cleveland, Ohio.
5 Cancer Prevention and Population Sciences Program, Baylor College of Medicine , Houston, Texas.
6 Department of Oncology, Karmanos Cancer Institute Population Studies and Disparities Research Program, Wayne State University School of Medicine , Detroit, Michigan.
7 Division of Preventive Medicine, University of Alabama-Birmingham , Birmingham, Alabama.
8 Department of Public Health Sciences, Hollings Cancer Center, Medical University of South Carolina , Charleston, South Carolina.
9 Moffitt Cancer Center , Tampa, Florida.
10 Epidemiology Program, Louisiana State University Health Sciences Center School of Public Health , New Orleans, Louisiana.
11 Department of Medicine, University of Tennessee Graduate School of Medicine , Knoxville, Tennessee.
12 Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond, Virginia.
13 Department of Public Health Sciences, University of Virginia , Charlottesville, Virginia.



Certain cultural, folk, and religious beliefs that are more common among African Americans (AAs) have been associated with later-stage breast cancer. It is unknown if these beliefs are similarly associated with delays in diagnosis of ovarian cancer.


Data from a multicenter case-control study of ovarian cancer in AA women were used to examine associations between cultural/folk beliefs and religious practices and stage at diagnosis and symptom duration before diagnosis. Associations between cultural/folk beliefs or religious practices and stage at diagnosis were assessed with logistic regression analyses, and associations with symptom duration with linear regression analyses.


Agreement with several of the cultural/folk belief statements was high (e.g., 40% agreed that "if a person prays about cancer, God will heal it without medical treatments"), and ∼90% of women expressed moderate to high levels of religiosity/spirituality. Higher levels of religiosity/spirituality were associated with a twofold increase in the odds of stage III-IV ovarian cancer, whereas agreement with the cultural/folk belief statements was not associated with stage. Symptom duration before diagnosis was not consistently associated with cultural/folk beliefs or religiosity/spirituality.


Women who reported stronger religious beliefs or practices had increased odds of higher stage ovarian cancer. Inaccurate cultural/folk beliefs about cancer treament were not associated with stage; however, these beliefs were highly prevalent in our population and could impact patient treatment decisions. Our findings suggest opportunities for health education interventions, especially working with churches, and improved doctor-patient communication.


African Americans; cultural beliefs; folk beliefs; ovarian cancer; religion


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