Social inequalities in breast cancer screening: evaluating written communications with immigrant Haitian women in Montreal

Abstract

Background The province of Quebec (Canada) has implemented a breast cancer screening program to diagnose this cancer at an early stage. The strategy is to refer women 50 to 69 years old for a mammogram every two years by sending an invitation letter that acts as a prescription. Ninety per cent (90%) of deaths due to breast cancer occur in women aged 50 and over. Numerous studies have shown social inequalities in health for most diseases. With breast cancer, a significant paradox arises: its incidence is lower among disadvantaged women and yet, more of them die from this disease. The health care system might play a role in this inequality. The scientific literature documents the potential for creating such inequalities when prevention does not consider equity among social groups. Immigrant women are often disadvantaged. They die of breast cancer more than non-immigrants. Studies attribute this to late-stage diagnosis due to poor adherence to mammography screening programs. Purpose of the study The main objective of our research is to assess how Haitian immigrant women in Montreal are reached by the Quebec Breast Cancer Screening Program, and specifically how they perceive the mammogram referral letter sent by the program. Methods The study uses a two-step qualitative method: i) In-depth interviews with influential community workers to identify the most relevant issues; ii) Focus groups with disadvantaged women from Montreal’s Haitian community. Results A mammogram referral letter from the Breast Cancer Screening Program may be a barrier to compliance with mammography by underprivileged Haitian women in Montreal. This might be attributable to a low level of literacy, poor knowledge of the disease, and lack of financial resources. Conclusion Barriers may be underestimated in underprivileged immigrant and non-immigrant communities. A preventive strategy must be adapted to different sub-groups and must also take into account lower literacy levels. To increase mammography uptake, it is crucial that the benefits of prevention be clearly identified and described in understandable terms. Finally, economic access to follow-up measures should be considered.

Health and healthcare equity within the Canadian cancer care sector: a rapid scoping review

“…Funding-specific policy recommendations focused on ensuring equitable access to cancer drugs and treatments [ 48 , 81 – 83 ], or funding specific services or interventions to address inequities [ 60 , 66 , 67 , 80 , 83 ]. Additional documents specified actions related to point of care improvements ( n = 19), including ensuring care is tailored to individual and/or community needs and addresses non-physical needs [ 34 , 70 , 84 ], as well as improving communication with patients (verbal and written) and scheduling more time at appointments [ 67 , 70 , 76 , 85 , 86 ]. Importantly, additional point of care actions included ensuring care is delivered in ways that mitigate stigma and bias, are anti-racist, culturally safe, trauma-informed, and welcoming and respectful [ 38 , 43 , 51 , 67 , 68 , 78 , 87 ].…”

Patterns and predictors of adherence to breast cancer screening recommendations in Alberta’s Tomorrow Project

“…Despite adjusting for a broad set of confounders, the possibility of residual confounding related to unmeasured potential confounders, such as physician referral patterns and breast self-examinations, exists. For example, ethnic minority group has been reported to have low mammography uptake compared with other populations ( Raynault et al, 2020 , Schwartz et al, 2021 ). However, the ethnicity variable was removed due to the small ethnic minority population in ATP dataset, which cannot support a model-based analysis.…”

Healthcare Inaccessibility of Asian Females in Canada: Barriers to Cancer Preventative Screening

“…The aim of their research was to investigate the factors contributing to health inequity within this population group. Additionally, the authors put up recommendations for communication tactics that are better suited to engage and impact the Haitian women community [12]. The author critiques the tendency to generalize the experiences of Asian immigrant females, arguing that social stigmatization was found to be an insignificant effect based on conversations with female Haitian interviewees.…”

“…This knowledge gap results in a lack of awareness regarding crucial healthcare practises, which becomes particularly significant in relation to mammography, as emphasised by Hulme et al's research [5]. Raynault et al highlight the significant information gap and limited awareness surrounding breast cancer and mammograms, which ultimately leads to the underutilization of mammography as a preventive approach [12]. Hulme et al have conducted a study that examines the low rates of breast cancer screening in the countries of origin for these women.…”