After reading this chapter, you will be able to:
· Explain the factors influencing Asian women’s breast cancer screening behavior
· Discuss the major barriers Asian women face in accessing the American health care system
· Discuss why and how to develop culturally and linguistically appropriate health promotion programs that can effectively promote early cancer detection in Asian communities.
·
Regular mammography screening is the best way to find
breast cancer early when it is most treatable.
·Asian women had lower cancer screening rates than any other U.S.
racial or ethnic population. Lower
utilization of breast cancer screening contributes to the fact that breast
cancer is found at later stages among Asian women.
·Multiple
factors influence Asian women’s breast and cervical cancer screening behavior,
including cultural, lingual, economic, psychosocial, and institutional barriers.
Breast cancer is the most frequently diagnosed cancer among Asian women. Knowing about this cancer and how it can be detected early can save a woman’s life. Cancer is as much a leading cause of death among Asian as in the general U.S. population. According to the American Cancer Society (1997), the breast is a leading cancer site among Chinese, Filipinos, Japanese, and Koreans. Cervical cancer is the most frequently diagnosed cancer for Vietnamese American women,21 though breast cancer is a close second.
Although Asian
women experience lower breast cancer incidence rates than Whites, their
survival rates at five years were roughly comparable (75% relative survival rate
for Chinese versus 73% for White). 22
This means that though Asians have a lower incidence rate
than Whites, an equal number are still dying from the disease. Moreover, the reported data on cancer incidence rates among Asians
may disguise the fact that subgroup populations have an increased risk
of cancer incidence or mortality. As
Asian women move to the U.S. from Asian and other countries, their chances of
getting breast cancer increases. The
risk of breast cancer in successive generations increases markedly and
approaches that among U.S. Whites.23
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3.2. Barriers to Breast and Cervical Cancer Screening in Asian Women
Regular mammography screening, combined with timely and appropriate treatment, can effectively reduce morbidity and mortality due to breast and cervical cancer. For a variety of reasons, sizable proportions of women of color sub-populations report that they do not avail themselves of preventive health tests such as Pap smears and mammograms on a regular basis.24 Asian women have lower rates of Pap test and breast cancer screenings than other U.S. racial or ethnic populations.25 54% of Asian women 40 years of age and older in 1991 reported not having had a mammogram in the past two years compared to 44% of Whites and 52% of Blacks in the same age group.26
the Susan G. Komen Breast Cancer Foundation has identified education as the key to the use of early detection. The assessment and identification of barriers are critically important in order to provide culturally and linguistically appropriate education, and to promote the use of breast cancer screening programs.
Conduct health related research projects is one of the important missions of the Healthy Asian Americans Project (HAAP) at the University of Michigan, School of Nursing. According to literature reviews and studies conducted by HAAP, some of the factors influencing Asian women’s cancer screening behavior are summarized below. If you would like to read the studies upon which the following conclusions are drawn, please go tour web site at www.umich.edu/~asianame/KTraining.html .
·
Sociodemographic Characteristics: Age, marriage status,
education level, income level, degree of English fluency, access to childcare, health
insurance coverage, and immigration history may influence Asian women’s
cancer screening behavior.
· Health Beliefs and Attitudes: Asians often practice preventive health through the regulation of diet and exercise. When seeking medical help, they may wait until critical signs of illness arise rather than using a combination of preventative screenings and doctor visits when problems appear.27 Many Asian women are too busy to visit health care providers because the well-being of the family is often placed above personal well-being. In addition, the general fears of radiation and mastectomy, as well as modesty, may prevent Asian women from having mammography screening. Furthermore, many women simply do not want to know if they have cancer because they equate its discovery to a death sentence. If similar values are shared by the community, these beliefs and habits are then confirmed and enforced among themselves.
·
Impact of Immigration: The barriers to cancer screening services in
recent immigrants include lack of knowledge about cancer screening and the
availability of low cost or free programs and unavailability of health insurance
and transportation. Communication styles and methods are also barriers for newly arrived
immigrants. Traditionally, Asian
women are taught to be obedient, respectful, and yielding.
Elderly parents who become dependents of others do not want to bother their
family members for rides and/or interpret during exams. Some immigrants also worry that participating in governmental health care
programs may have an adverse impact on their green card application.
Illegal immigrants generally do not believe in the confidentiality of the
programs and fear revealing any information that may be used to locate them.
Consequently, they are unwilling to participate in most preventive care
programs.
· Linguistic Barriers: The ability to communicate and interact effectively in English is a major barrier to accessing medical care. Furthermore, a lack of cancer screening information translated into appropriate Asian languages also contributes to Asian women’s neglect of breast health care. Even for those people who have a high degree of fluency, special health terminology may prevent effective communication.
·
Misconceptions: One of the misconception, which adversely impacts Asian women’s
cancer screening behavior, is that Asian women have a lower risk of breast.
Consequently, some funding agencies believe that there is no
need to spend money for the Asian community and some health care providers
believe Asian women do not need breast health care.
·
Institutional Barriers: Few female physicians and an absence of
educational campaigns are some of the institutional barriers that contribute to
Asian women neglect breast health. Lack
of familiarity with, and trust in, the American health care system may prevent Asian
women from seeking breast cancer screening. For women who do get
primary care, a physician’s referral has been proven by various studies to
increase women’s screening frequency. On
the other hand, the lack of cultural competency training in medical or
professional education may leave many health providers lacking the knowledge and
tools to deal effectively with Asian American women. 28
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