Diversity matters: Unique populations of women and breast cancer screening

Abstract

BACKGROUND. Ethnic differences in breast cancer screening behaviors are well established. However, there is a lack of understanding regarding exactly what causes these differences and which characteristics in low-screening populations should be targeted in an effort to modify screening behavior. METHODS.Stratified cluster sampling was used to recruit 1364 women (ages 50 -70 years) from 6 ethnic groups: African-American women; U.S.-born white women;English-speaking Caribbean, Haitian, and Dominican women; and immigrant Eastern-European women. In interviews, respondents provided information concerning demographic and structural variables related to mammogram utilization (age, education, income, marital status, physician recommendation, access, and insurance) and a set of cognitive variables (fatalism, perception of personal risk, health beliefs concerning cancer) and socioemotional variables (stress, cancer worry, embarrassment, and pain). RESULTS.For data analysis, the authors used a 2-step logistic regression with frequency of mammograms over a 10-year period (Յ 4 mammograms over 10 years or Ն 5 mammograms over 10 years) as a dependent variable. U.S.-born AfricanAmerican women and Dominican women were screened as frequently as European-American women, but the remaining minority groups were screened with less frequency. With one exception, ethnicity ceased to predict screening frequency once cognitive and emotional variables were controlled. CONCLUSIONS.Although women from clearly operationalized ethnic groups continue to screen at rates substantially below those of the majority groups, these differences appear to be explained substantially by differences in psychologic variables. This is encouraging because, rather than targeting culture for interven- B reast cancer is the second most common malignancy in women. 1 Although there has been some recent controversy, 2 a number of studies and reviews have shown that mammography reduces mortality, 3,4 and several authors have argued that early detection and screening represent our best means for decreasing breast cancer mortality. [5][6][7] Across the last 2 decades, a large body of descriptive research has documented the background factors that are believed to act barriers to, and facilitators of, mammography. In general, greater age, 8 -13 lower income and education, 14 -16 single marital status, 10 the absence of insurance, 17 and lack of physician recommendation 6,18 -20 all were reported to be predictive of poorer mammography utilization. Minority women also are less likely to have regular mammograms, a finding that is attributed commonly to lower education and income. What is of interest, however, is that ethnic differences in screening behavior persist even when variables such as socioeconomic status or education do not differ or are controlled statistically. 7,21,22 A growing number of screening studies also have examined an array of cognitive, attitudinal, and emotional factors that act as barriers to regular screening: patient perceptions of vulnerability,...

Prostate Cancer Screening Behavior in Men from Seven Ethnic Groups: the Fear Factor

“…5 Second, the effect sizes for the psychological variables are small, although their magnitude was on par with those of known predictors of screening, including age and income. Perhaps more importantly, whereas age and income are immutable for intervention purposes and are better suited to identifying ''at-risk'' populations, psychological characteristics may be particularly amenable to change (47); modest effects may be of considerable practical significance (37). It seems likely, for example, that a modicum of dispositional anxiety is useful in promoting more active screening profiles, although how such anxiety might best be activated remains unclear at this point.…”

“…Missing from this developing picture thus far, however, is a systematic examination of the emotion and emotion regulatory variables that breast cancer screening research has suggested may be critical to understanding screening in diverse populations (47,48). One study examined prostate cancer worry in relation to prostate screening, although it focused on differences between symptomatic and asymptomatic men (49).…”

Mexican Immigrant Male Knowledge and Support Toward Breast and Cervical Cancer Screening

“…Data on cancer incidence, mortality, and health disparities among immigrants in the U.S. remain limited [4][5][6][7]. Immigrant minorities continue to experience disproportionately higher cancer incidence and mortality rates for many cancers [8,9].…”

Cancer Screening and Haitian Immigrants: The Primary Care Provider Factor

“…Consedine et al found that Haitian men reported significantly lower prostate cancer screening compared with U.S. born whites [3]. Haitian women have been found to be less likely to utilize breast cancer screening [4,5], and have lower Papanicolaou (Pap) test screening rates than native-born Black and Latina peers [6], and a higher incidence of invasive cervical cancer than U.S.-born black women [7]. Regardless of ethnicity or socioeconomic status, increasing cancer screening results in early detection of many cancer types, lowers incidence of late stage cancer diagnosis, and improves cancer outcomes, considerably enhancing survival rates [8].…”