Dismissive Care, Not Fear Alone, Drives Black Women Away From Cancer Screening

Breast and cervical cancers are among the most treatable malignancies when caught early, yet they remain leading causes of cancer-related illness and death among women in the United States, with racial and ethnic disparities that have stubbornly persisted across decades of public health progress. A new mixed-methods study from Illinois suggests that a frequently underestimated barrier sits not in the biology of the disease or even primarily in the logistics of access, but in the interpersonal texture of healthcare itself: how women are spoken to, listened to, and treated during clinical encounters. The research, led by Jessica D. Rothstein and colleagues at the University of Illinois Chicago School of Public Health and published in BMC Health Services Research, examined how experiences within healthcare delivery, including interactions with providers and staff, shape breast and cervical cancer screening behaviors among Black women across Illinois.

The study’s title quote, drawn from participant testimony, captures the core finding in a single sentence: “You guys don’t listen to us.” Prior research on cancer screening barriers has concentrated heavily on individual-level determinants, such as knowledge and attitudes, and structural determinants, such as insurance coverage and transportation, with comparatively little attention paid to the interpersonal level of influence. The Illinois team designed their investigation to fill that gap, working in partnership with a statewide safety-net screening program to reach women whose experiences reflected the realities of the systems intended to serve them.

Methodologically, the researchers employed an exploratory sequential mixed-methods design, a structure in which qualitative findings are gathered first and then used to build a quantitative instrument. They conducted in-depth interviews with 35 Black Illinoisan women between the ages of 21 and 64 who had experienced challenges accessing breast or cervical cancer screening. Interview transcripts were analyzed thematically, allowing recurring patterns of experience to surface from the data rather than being imposed by predefined categories. Those themes then informed a structured survey administered to 233 Black women across the state, whose responses were analyzed descriptively and stratified by age, geography, and insurance status to determine how prevalent and how widely distributed the reported barriers were. Triangulating the two data streams provided a more comprehensive picture than either approach could deliver alone.

The geographic reach of the sample was notable: participants represented 22 Illinois counties, spanning urban, suburban, and rural contexts. In the interviews, women described negative healthcare encounters characterized by poor communication, dismissive treatment, and limited explanation during screening procedures themselves. Providers and staff were frequently described as rushed, disrespectful, and discriminatory, and these encounters eroded trust in the healthcare system in ways that extended well beyond a single appointment. The qualitative analysis revealed something more subtle and more consequential than isolated bad experiences: women interpreted structural failures, such as long wait times for care, through the lens of prior interpersonal mistreatment, reading delays and inefficiencies as manifestations of racism and discrimination rather than as neutral system glitches.

The survey results quantified how widespread these experiences are. Among the 233 respondents, 56.8 percent reported feeling dismissed by providers or staff, 64.4 percent reported experiencing discrimination in healthcare settings, and 62.2 percent reported avoiding medical care because they feared unfair treatment. Perhaps most striking, across every age group examined, prior negative healthcare experiences were the most commonly reported reason for delaying or avoiding screening, cited by 64.8 percent of respondents. In other words, the interpersonal barrier outranked the structural and informational barriers that have historically anchored screening interventions.

These findings carry significant technical implications for the science of cancer disparities. The social ecological model, which organizes influences on health behavior into nested levels ranging from individual to policy, has long implied that interventions targeting a single level will underperform. This study provides empirical weight to that argument at the interpersonal tier, demonstrating that patient-provider communication functions as a correlate of preventive care uptake in its own right, not merely as a mediating variable between structural access and behavior. The results also align with a growing literature on healthcare discrimination and its physiological and behavioral consequences, including documented associations between perceived mistreatment and avoidance of preventive services, delayed diagnosis, and worse cancer outcomes.

The behavioral mechanism the researchers describe is essentially a trust-erosion cascade. A dismissive encounter during a Pap test or clinical breast exam reduces the perceived payoff of returning for future screening, raises the anticipated cost of the next appointment in emotional terms, and generalizes across the healthcare system so that even unrelated structural delays are recoded as evidence of unfair treatment. Once that recoding occurs, avoidance becomes a rational protective strategy from the patient’s perspective, even as it increases the risk that a highly treatable cancer is detected at a later, less survivable stage. This helps explain why simply adding screening capacity or sending reminders often fails to move uptake among populations whose trust has already been depleted.

The authors conclude that efforts to improve screening uptake must therefore address both patient-provider communication and the structural aspects of care delivery simultaneously. They call for multilevel interventions designed to improve care quality, rebuild trust, and ultimately reduce racial inequities in screening, early detection, and cancer-related mortality. In practical terms, such interventions could include communication training for providers and staff in safety-net settings, community health worker models that bridge clinical systems and patient communities, and policy, system, and environmental strategies that reshape the delivery context rather than the patient. The study was conducted in partnership with the Illinois Department of Public Health, whose statewide safety-net screening program provided the operational foundation for the work, and it was funded in part through Illinois Department of Public Health interagency agreements.

The research team emphasizes that the findings identify negative and discriminatory healthcare encounters as important correlates of screening behavior among Black women, and that the prevalence figures from the survey indicate these experiences are not anomalies confined to a few bad actors but systemic patterns distributed across age groups and geographies. The interviews were approved by the Institutional Review Board at the University of Illinois Chicago, with survey participants providing written informed consent and interview participants providing verbal informed consent and audio-recording permission before each session. The article is published open access under a Creative Commons license, allowing the findings to circulate freely among clinicians, policymakers, and community advocates who might use them.

For a science readership, the study’s most viral implication is its reframing of a familiar narrative. The barriers that keep Black women from lifesaving cancer screening are not primarily about fear of the procedure, ignorance of the guidelines, or even the absence of insurance, though those matter. They are about being rushed, dismissed, and disrespected in the exam room, and about a healthcare system that women say does not listen. The quote that anchors the paper is not an anecdote; it is a measurement. And the measurement says that the interpersonal quality of care is a modifiable determinant of cancer disparity, one that clinicians, health systems, and policymakers can act on now, before the next generation of screening reminders goes unanswered.

Subject of Research: Health Services Research

Article Title: “You guys don’t listen to us”: a mixed methods study of barriers to breast and cervical cancer screening among black women

Article References: Rothstein, J. D., Miller, W. E., Jiang, Y., Callen, B., Zdunek, S., Handler, A., & Carnahan, L. R. (2026). “You guys don’t listen to us”: a mixed methods study of barriers to breast and cervical cancer screening among black women. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15615-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15615-7

Keywords: cancer screening, health disparities, patient-provider communication, healthcare discrimination, breast cancer, cervical cancer, preventive care, mixed methods, guys, listen, mixed, methods