"There is some, perhaps appropriate, distrust of the medical community," said Smitherman. "It's been shaped from the Tuskegee study on down, and this is passed down through the generations," he added, referring to a notorious study in which black men were not informed of their diagnosis of syphilis, and in some cases, were denied treatment.
"All sorts of perceptions in society can affect the relationship with the physician. Patients ask themselves, 'can I trust this person with my life?'"
Breast cancer survivor Durham said she believes there are additional cultural issues that may play a role in patients' abilities to make the right choices.
"Some women, especially in our [black] culture and especially older women, may think of doctors as such an authority figure, they are afraid to ask questions and afraid they may sound stupid."
One possible solution is that patients diagnosed with breast cancer particularly blacks need to take a more active role in educating themselves and advocating for their choices.
"I would say, you're [the patient is] going to have to educate yourself," Smitherman said. "Part of being in the health-care system is that you have to get knowledge. You'll have to get on the Internet and look up stuff, and come prepared when you come into the physician's office."
"Write down your questions. Just like when you go to your accountant, or church, or a talk, be prepared ahead of time."
Durham agreed that patients need to have the ability to take ownership over their disease. Today she works as a program specialist for Encore Plus, an outreach and education program for breast and cervical cancer targeted at minority and medically underserved women.
"When I'm out in the [black] community talking about breast cancer, I tell people, 'we have to be our own best advocates.'"
"Patients need to talk to other women that have the disease, go into a support group setting. Where you lack understanding, search for it until you get it."