This study provides the basis for customizing culturally responsive social work health promotion programs aimed at eliminating breast cancer screening and mortality disparities between white and African American women. Survey data collected from a random sample of 853 women in rural North Carolina were used to explore the impact of psychosocial factors, including cultural beliefs, on differences by race and age in behavioral intentions if a breast lump was found. Multivariate logistic regression analysis revealed that age and past mammography screening predicted the intention to get a mammogram, whereas physician communication about breast cancer risk, never having a mammogram, breast cancer worry, and religious beliefs about God's role in curing cancer influenced women's intentions to watch the lump for changes. Factors in both models did not account for racial differences. The findings can help social workers tailor more culturally respectful breast health interventions and have implications for the development of other efforts to eliminate health disparities.