Breast cancer screening among Cambodian American women

Our aim was to describe and identify factors associated with breast cancer screening among Cambodian American women. We conducted a cross-sectional survey of 1,365 households using bilingual and bicultural interviewers. We found that low proportions of Cambodian American women were up to date on their clinical breast examinations (CBE; 42%) and mammograms (40%). More than 80% of women with female physicians have had at least one prior screening, and 52% have had the tests recently. Women with male Asian American physicians were less likely to have had screening as compared to women with female non-Asian physicians: ever had CBE (odds ratio [OR], 0.26); recent CBE (OR, 0.39); ever had mammogram (OR, 0.36); and recent mammogram (OR, 0.22). Breast cancer screening among Cambodian American women lags behind the general U.S. population. Tailored promotion efforts should address barriers and promote cancer screening by physicians, staff, and organizations serving this population.     

Breast cancer in African American women: Epidemiology and tumor biology

Summary This review of published data on the epidemiology, pathology, and molecular biology of breast cancer in African American women seeks to identify how the etiology and presentation of the disease differ from those in white women. The crossover from higher to lower age-specific incidence rates in African American women at age 45 cannot be explained by current data on the distribution of risk factors. Data from six case-control studies suggest that the relative risks associated with both established and probable breast cancer risk factors are similar in African American and white women. Lower survival in African American compared to white women is primarily attributable to diagnosis at a later stage. However, evidence from a number of studies suggests that tumors in African American women may exhibit a more aggressive phenotype, which could also contribute to the survival disparity. Tumors in African American women are more likely to occur at a younger age, to be poorly differentiated and estrogen receptor negative, and to exhibit high grade nuclear atypia, more aggressive histology (more medullary and less lobular), and higher S-phase. Overexpression of p53 and erbB-2 occurs with similar frequency in African American and white women, although limited data suggest the former may exhibit different p53 mutation spectra. One study found high risk associated with a specific CYP1A1 polymorphism in African American but not white women. Additional studies of molecular differences in African American and white women are needed, with multifactorial assessment of the independent effects of molecular and conventional risk attributes.     

Breast care screening for underserved African American women: Community-based participatory approach

Traditional health promotion models often do not take into account the importance of shared cultural backgrounds, beliefs, and experiences unique to underserved African American women when designing community-based cancer screening and prevention programs. Thus, the purpose of this study was the development, implementation, and evaluation of a community-based participatory research (CBPR) program designed to increase breast cancer screening awareness in an underserved African American population by providing culturally appropriate social support and information. The study includes 357 African American women who participated in the program and completed the 6-month follow-up questionnaire. The program consisted of a 45-minute play, using community members and storytelling to honor and incorporate five different cultural experiences (skits) with breast care and cancer. Overall, findings indicate that the educational intervention was effective. In addition, these findings are consistent with the literature that suggests that educational interventions that include knowledge to alleviate concerns, dispel myths, and create awareness can increase breast cancer screening participation rates. Furthermore, these findings confirm the importance of CBPR in health promotion activities in reducing health and cancer disparities.     

Breast cancer screening knowledge, attitudes, and practices among Korean American women

PURPOSE/OBJECTIVES: To describe the knowledge and beliefs about breast cancer and breast cancer screening and practices of clinical breast examination (CBE) and mammography of Korean American women. DESIGN: Cross-sectional survey. SETTING: Two Korean churches in a mid-sized Southeastern U.S. city. SAMPLE: A convenience sample of 107 Korean women ages 40 and older. METHODS: Data were collected using Champion's Health Belief Model instrument (susceptibility, seriousness, benefits, and barriers) and the Breast Cancer Knowledge test through mailed questionnaires. MAIN RESEARCH VARIABLES: Knowledge and beliefs about breast cancer screening and practices of CBE and mammography. FINDINGS: The percentages of Korean American women who ever had a CBE and mammography were 67 and 58, respectively. Among the Health Belief Model variables, women who never had a CBE had significantly lower knowledge scores and higher perceived barriers to CBE than those who had. Women who never had a mammogram reported significantly higher perceived barriers to mammography. Logistic regression analyses demonstrated that husband's nationality, regular checkups, and encouragement from family members and physicians were significant predictors of CBE and mammography use. CONCLUSIONS: The frequency of breast cancer screening practices among Korean American women is below national objectives. IMPLICATIONS FOR NURSING PRACTICE: As healthcare professionals in a culturally diverse nation, nurses need to increase their awareness of cultural variations and provide culturally and linguistically appropriate breast health education. Additional studies with women from a variety of settings are needed to validate present study findings.     

Breast cancer screening: stages of adoption among Cambodian American women

BACKGROUND: Little information is available on the breast cancer screening behavior of Cambodian American women. METHODS: We identified households from multiple sources using Cambodian surnames and conducted a cross-sectional survey, administered by bilingual and bicultural interviewers. Breast cancer screening stages of adoption were examined based on concepts from the transtheoretical model of behavioral change. RESULTS: Our response rate was 73% (398 women in clinical breast exam (CBE) analysis, and 248 in mammography analysis) with approximately 25% each in the maintenance stage. We found significant associations between screening stage with physician characteristics. Asian American female physician increased the likelihood of being in the maintenance stage (CBE, OR = 10.1, 95% CI 2.8-37.1; mammogram, OR = 74.7,95% CI 8.3-674.6), compared to Asian American male physician with precontemplation/contemplation stage as our referent outcome. CONCLUSION: Results from this study support the need to promote regular breast cancer screening among Cambodian American women.     

Breast cancer and screening in American Indian and Alaska Native women

Data relative to breast cancer among American Indian and Alaska native (AI/AN) women are limited and vary by regions. Despite national decreases in breast cancer incidence and mortality rates, declines in these measures have not yet appeared among AI/AN women. Health disparities in breast cancer persist, manifest by higher stage at diagnosis, and lower screening rates compared to other racial and ethnic groups. Disproportionately more AI/AN are younger at diagnosis. Screening beginning at age 40, improving access, annual rescreening, community education and outreach, and mobile mammography for rural areas are ways to improve these disparities in breast cancer.     

Breast cancer in Sub-Saharan African women: review

Breast cancer is the second most frequent cancer in Sub-Saharan African women with an incidence of 15-53 per 100,000 women. Using PubMed, we reviewed all the articles published on this topic between 1989 and 2009. Breast cancer is usually diagnosed in women younger than in developed countries (mean age: 42-53 years), with later stages (III or IV, i.e. with axillary nodes and distant metastases). Reported tumors are mostly invasive ductal carcinomas with aggressive characteristics: grade III histoprognosis, absence of hormonal receptors or HER2 expression. According to the new breast cancer classification, nearly half of these tumors should be classified as triple negative. However, studies are rare and require confirmation. In conclusion, data on epidemiology and biology of breast cancer in Sub-Saharan African women are still scarce and need more extensive studies. In these countries, the pattern of breast cancer will likely change in the future, according to the evolution of lifestyle namely urbanisation. There is a great need for commitment of research and clinical resources in Sub-Saharan Africa in order to develop specific strategies.     

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

Background:

Cancer fear and fatalism are believed to be higher in ethnic minorities and may contribute to lower engagement with cancer prevention and early detection. We explored the levels of cancer fear and fatalism in six ethnic groups in the United Kingdom and examined the contribution of acculturation and general fatalism.

Methods:

A cross-sectional survey of 720 White British, Caribbean, African, Indian, Pakistani, and Bangladeshi women (120 of each) was conducted. Three items assessed cancer fear and two cancer fatalism. Acculturation was assessed using (self-reported) migration status, ability to speak English, and understanding of health leaflets; general fatalism with a standard measure.

Results:

Relative to White British women, African and Indian women were more fearful of cancer, Bangladeshi women less fearful, and Pakistani and Caribbean women were similar to White British women. Cancer fatalism was higher in all the ethnic minority groups compared with White British women. Less acculturated women were less likely to worry (ORs 0.21–0.45, all P<0.05) or feel particularly afraid (ORs 0.11–0.31, all P<0.05) but more likely to feel uncomfortable about cancer (ORs 1.97–3.03, all P<0.05). Lower acculturation (ORs 4.30–17.27, P<0.05) and general fatalism (OR 2.29, P<0.05) were associated with the belief that cancer is predetermined.

Conclusions:

In general, cancer fear and fatalism are more prevalent among ethnic minority than White British women and even more so in less acculturated ethnic minorities. This may affect their participation in cancer prevention and early detection.     

Breast cancer in black American women

A case-control study of breast cancer among Black American women was conducted in seven hospitals in New York City from 1969 to 1975. Results are reported for 127 cases and 317 controls. Compared to women with a first birth before age 19, those with a first birth after 25 had a relative incidence rate for breast cancer of 3.8 and 2.2 for the pre- and postmenopausal age-groups, respectively. Compared to nulliparous women, parous women had a relative incidence rate of 0.6 for premenopausal and 0.7 for postmenopausal women. The incidence rate of breast cancer for women with a menopause after age 49 was estimated to be 3.1 times that of women with a menopause before age 45. Thus, the known risk factors for breast cancer among Whites are also related to the etiology of the disease among Blacks. The incidence rate of breast cancer has increased among younger Blacks since 1947 and is now similar to that among younger Whites. However, among older women, the incidence rate is still appreciably higher for Whites. The most likely explanation of this pattern is that Black women born since about 1925 are being exposed at the same frequency as White women to the causes of breast cancer.     

Family history of cancer predicts Papanicolaou screening behavior for African American and white women

BACKGROUND:

Understanding women's motivations for getting Papanicolaou (Pap) screening has the potential to impact cancer disparities. This study examined whether having a family history of cancer was a predictor for Pap screening.

METHODS:

By using the National Health Interview Survey 2000 Cancer Control and Family modules, we identified a subsample (n=15,509) of African American (n=2774) and white women (n=12,735) unaffected by cancer, with and without a family history of cancer. Data were analyzed using logistic regression models.

RESULTS:

African American and white women with a positive family history of cancer were 42% (P < .0001) more likely to have had a recent Papanicolaou (Pap) test than their counterparts without a family history of cancer. Among African American women, those with a positive family history of cancer were 53% more likely to have had a recent Pap test, whereas among white women those with a positive family history of cancer were 41% more likely to have received a Pap test. African American women with a family history of cancer were more likely to have had a recent Pap test than white women with or without a family history of cancer.

CONCLUSIONS:

This study presents a unique perspective on Pap screening behavior. Having an immediate family member with any cancer statistically predicted having a recent Pap test for both African American and white women. Because these results demonstrated that regardless of the cancer type, having an immediate affected family member is a motivator for cervical cancer screening behavior, healthcare providers managing cancer treatment patients have a teachable opportunity that extends beyond the patient. Cancer 2009. © 2008 American Cancer Society.