Determinants of mammography screening participation among Turkish immigrant women in Germany - a qualitative study reflecting key informants' and women's perspectives

The purpose of this review was to better understand possible social, economic, cultural, behavioral, and systems barriers to breast cancer screening among minority women. Relevant manuscripts were identified through a MEDLINE/PubMed search for English-language literature from October 1971 through April 2009. The abstracts from a total of 515 manuscripts were reviewed. Only studies conducted among minority women in the United States and examining barriers related to screening mammography were considered. Of 64 relevant articles, 13 cross-sectional and 4 prospective studies met inclusion criteria. Study design; patient characteristics; outcomes regarding knowledge, attitudes and beliefs; social norms; accessibility; and cultural competence regarding breast cancer screening were abstracted. Studies were rated using a methodological quality score (MQS). Pain and embarrassment associated with screening mammography, low income and lack of health insurance, poor knowledge about breast cancer screening, lack of physician recommendation, lack of trust in hospitals and doctors, language barriers, and lack of transportation were the most frequently identified barriers. The average MQS of the studies selected was 10.9 (SD = 3.25, range, 4-20). Multiple barriers limit screening mammography among minority women. Recognizing predictors of screening among minority women and addressing culturally specific barriers may improve utilization of screening mammography among these women. Show more

Background Breast screening uptake in London is below the Government's target of 70% and we investigate whether ethnicity affects this. Information on the ethnicity for the individual women invited is unavailable, so we use an area-based method similar to that routinely used to derive a geographical measure for socioeconomic deprivation. Methods We extracted 742,786 observations on attendance for routine appointments between 2004 and 2007 collected by the London Quality Assurance Reference Centre. Each woman was assigned to a lower super output (LSOA) based on her postcode of residence. The proportions of the ethnic groups within each LSOA are known, so that the likelihood of a woman belonging to White, Black and Asian groups can be assigned. We investigated screening attendance by age group, socioeconomic deprivation using the Index of Deprivation 2004 income quintile, invitation type and breast screening service. Using logistic regression analysis we calculated odds ratios for attendance based on ethnic composition of the population, adjusting for age, socioeconomic status, the invitation type and screening service. Results The unadjusted attendance odds ratios were high for the White population (OR: 3.34 95% CI [3.26-3.42]) and low for the Black population (0.13 [0.12-0.13]) and the Asian population (0.55 [0.53-0.56]). Multivariate adjustment reduced the differences, but the Black population remained below unity (0.47 [0.44-0.50]); while the White (1.30 [1.26-1.35]) and Asian populations (1.10 [1.05-1.15]) were higher. There was little difference in the attendance between age groups. Attendance was highest for the most affluent group and fell sharply with increasing deprivation. For invitation type, the routine recall was higher than the first call. There were wide variations in the attendance for different ethnic groups between the individual screening services. Conclusions Overall breast screening attendance is low in communities with large Black populations, suggesting the need to improve participation of Black women. Variations in attendance for the Asian population require further investigation at an individual screening service level. Show more

Arab women have undergone major modernization processes in recent years and the effect of these processes on attitudes to screening should be examined. Fifty-one Israeli Arab women participated in focus groups in five representative communities. The women expressed a combination of traditional beliefs and modern biomedical knowledge concerning risk and preventive factors related to cancer. Special importance was given to birth and breast-feeding as protective factors, integrating modern views with traditional concepts of motherhood as a woman's principal role in society. A major theme on who or what was responsible for one's health emerged, opinions ranging across fate and God's will, physicians and health services, or, as a substantial number of participants asserted, taking personal responsibility for one's health. A related theme that emerged was the perception of cancer as either a punishment or as a test devised by God. Fears of stigma related to breast or gynecological examinations, worries about the spouse's reaction once a lump is detected, and worries regarding the violation of religious and cultural requirements of modesty, were expressed. However, there was firm agreement that although these created emotional difficulties, they were not sufficiently important to cause women to forgo screenings. Show more