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Abstract

Cultural beliefs have been hypothesized to be powerful barriers to breast cancer screening in minority women and physician recommendation is consistently reported to be the strongest incentive. This study investigated (1) beliefs regarding breast cancer and (2) the perception of barriers to mammography and clinical breast examination in a sample of immigrant Tamil women, as well as in a sample of primary care physicians. Three focus groups, each consisting of 10 immigrant Tamil women from Sri Lanka aged 50 years or over were conducted and 52 primary care physicians who serve this population completed mailed surveys. The most common barriers to screening reported by the women were (1) lack of understanding of the role of early detection in medical care, (2) religious beliefs and, (3) fear of social stigmatization. Physicians reported the most common barriers to their screening recommendations for this group of women to be (1) women's episodic care, (2) unrelated presenting problems and, (3) women refusing to be screened. Interventions to increase screening in this and other minority groups requires an elaborated understanding of utilization barriers for both women and their doctors.

A systematic review of barriers and enablers to South Asian women’s attendance for asymptomatic screening of breast and cervical cancers in emigrant countries

“…Neither cancer nor intimate body parts are commonly discussed in some South Asian cultures. 42 46 All studies showed that women lacked basic understandings of cancer, cancer prevention or early detection. Breast cancer was viewed by some women as a ‘ white woman’s disease’ 41 that did not occur in their community.…”

“…First, religious fatalism meant that cancer was seen as predestined, as divine retribution for sins or as a dearth of moral character. 42 Second, all studies pointed to the curative focus of healthcare in countries of origin as a reason for some women’s failure to understand the concept of prevention 42 48 and consequent belief that healthcare seeking is unnecessary in the absence of symptoms. 41 44 46 49 …”

“… 49 Both breast and cervical cancer were seen as stigmatising 46 and to some women this extended to screening. 42 45 Indeed, some Sri Lankan Tamils worried that attending a mammogram would lead people to think they already had breast cancer. 42 Third, women’s behaviour was often subject to influence from male members of the family.…”

Awareness of breast cancer among adolescent girls in Colombo, Sri Lanka: a school based study

“…Awareness and health seeking practices have been shown to be poor in many developing countries, necessitating the need for proper awareness programs [8,9]. The only published study from Sri Lanka, conducted in a population of Tamil immigrants, identified poor knowledge and cultural conservatism as barriers in implementing breast cancer screening programmes [10]. …”

Cancer fear and fatalism among ethnic minority women in the United Kingdom

“…The differences in levels of cancer fear and fatalism across ethnic groups suggest that other cultural factors, such as language spoken and migration status, may have a role in explaining variations in these variables. For some ethnic groups, language barriers may impede understanding of the preventive purpose of cancer screening tests, which may increase levels of cancer fear when offered one ( Meana et al , 2001 ; Austin, 2009 ). Language barriers may also have a role in perpetuating fatalistic beliefs: 62% of Spanish-speaking Latinos believed that cancer was not preventable, vs 40% of English-speaking Latinos ( Ramírez et al , 2013 ).…”