Abstract
Background
Though breast cancer is the most common malignancy among Chinese women, screening mammography is underutilized. This study examined barriers and facilitators of screening mammography among Chinese Canadian women.
Methods
Using community-based sampling, Chinese women in British Columbia were interviewed in 1999 about multiple preventive health behaviours. We included 213 women in the mammography analysis; main outcome measures were ever having a mammogram and routine mammography.
Results
Seventy-five percent of women 50 to 79 years old reported ever having had a mammogram, and 53% had two or more mammograms within the last five years. Receiving a recommendation for a mammogram from medical personnel or from a family member, and believing that cancer cannot be prevented by faith were independently associated with both screening outcomes.
Conclusions
A multifaceted approach to screening mammography promotion in Chinese Canadian women is suggested. Interventions that include education of and by medical providers and family members should be considered.
Résumé
Contexte
Le cancer du sein est la tumeur maligne la plus répandue chez les Chinoises, mais la mammographie de dépistage est sous-utilisée. L’étude porte sur les obstacles et les facteurs facilitants de cet outil de dépistage chez les Canadiennes d’origine chinoise.
Méthode
Par échantillonnage à L’échelon de la collectivité, nous avons interviewé des Chinoises de Colombie-Britannique en 1999 au sujet de divers comportements préventifs liés à la santé. L’analyse des données sur la mammographie portait sur 213 femmes; nos principaux indicateurs de résultats étaient le fait d’avoir déjà eu une mammographie et le fait d’en avoir périodiquement.
Résultats
Soixante-quinze p. cent des femmes de 50 à 79 ans ont dit avoir déjà eu une mammographie, et 53 % en avaient eu deux ou plus au cours des cinq années précédentes. Les deux indicateurs étaient indépendamment associés au fait qu’un membre du personnel médical ou de la famille ait recommandé une mammographie et à la conviction que la foi ne peut prévenir le cancer.
Conclusion
Nous suggérons une approche multidimensionnelle pour la promotion de la mammographie de dépistage auprès des Canadiennes d’origine chinoise. Il faudrait envisager des mesures comme la sensibilisation des dispensateurs de soins médicaux et des membres de la famille.
Footnotes
Acknowledgements: Funded, in part, by grant CA74326 and cooperative agreement CA86322 from the National Cancer Institute of the United States. We thank the women who participated in these interviews; the interviewers: C. Chan, I. Chan, L. Hsu, A. Ko, S. Leung, M. Li, J. Ng, E. Ng, C. Pang, G. Troung; the community advisory coalition: I. Chan and L. Lai (Canadian Cancer Society), Dr. J. Ko (Taiwanese Canadian Cultural Society), G. Mumick (Vancouver-Richmond Health Board), S. Leung (SUCCESS), Dr. L. Sent (Asian Women’s Health Clinic), Dr. C. Wang (Chinese Canadian Medical Society), and Dr. M. Yu (Chinese Cultural Centre)
References
- 1.Miller B, Kolonel L, Bernstein L, Young JL, Swanson GM, West CR, et al. Racial/Ethnic Patterns of Cancer in the United States 1988–1992. Bethesda, MD: National Cancer Institute; 1996. [Google Scholar]
- 2.Li FP, Pawlish K. Cancers in Asian Americans and Pacific Islanders: Migrant studies. Asian Am Pac Isl J Health. 1998;6(2):123–29. [PubMed] [Google Scholar]
- 3.Wu AH, Ziegler RG, Horn-Ross PL, Nomura AM, West DW, Kolonel LN, et al. Tofu and risk of breast cancer in Asian-Americans. Cancer Epidemiol Biomarkers Prev. 1996;5(11):901–6. [PubMed] [Google Scholar]
- 4.Yu H, Harris RE, Gao YT, Gao R, Wynder EL. Comparative epidemiology of cancers of the colon, rectum, prostate and breast in Shanghai, China versus the United States. Int J Epidemiol. 1991;20(1):76–81. doi: 10.1093/ije/20.1.76. [DOI] [PubMed] [Google Scholar]
- 5.Ziegler RG, Hoover RN, Pike MC, Hildesheim A, Nomura AM, West DW, et al. Migration patterns and breast cancer risk in Asian-American women. J Natl Cancer Inst. 1993;85(22):1819–27. doi: 10.1093/jnci/85.22.1819. [DOI] [PubMed] [Google Scholar]
- 6.Stanford JL, Herrinton LJ, Schwartz SM, Weiss NS. Breast cancer incidence in Asian migrants to the United States and their descendants. Epidemiology. 1995;6(2):181–83. doi: 10.1097/00001648-199503000-00017. [DOI] [PubMed] [Google Scholar]
- 7.Koh HK, Sun T, Zhang YQ. Asian Am Pac Isl J Health. 1996. Cancer in Asian Americans and Pacific Islander Populations. [PubMed] [Google Scholar]
- 8.Yu MY, Seetoo AD, Tsai CK, Sun C. Sociodemographic predictors of Papanicolaou smear test and mammography use among women of Chinese descent in southeastern Michigan. Womens Health Issues. 1998;8(6):372–81. doi: 10.1016/S1049-3867(98)00020-6. [DOI] [PubMed] [Google Scholar]
- 9.Lee M, Lee F, Stewart S. Pathways to Early Breast and Cervical Detection for Chinese American Women. Health Educ Q Suppl. 1996;23:S77–S88. [Google Scholar]
- 10.Yu ESH, Kim KK, Chen EH, Brintnall RA. Breast and Cervical Cancer Screening among Chinese American Women. Cancer Pract. 2001;9(2):81–91. doi: 10.1046/j.1523-5394.2001.009002081.x. [DOI] [PubMed] [Google Scholar]
- 11.Kagawa-Singer M, Pourat N. Asian American and Pacific Islander breast and cervical carcinoma screening rates and healthy people 2000 objectives. Cancer. 2000;89(3):696–705. doi: 10.1002/1097-0142(20000801)89:3<696::AID-CNCR27>3.0.CO;2-7. [DOI] [PubMed] [Google Scholar]
- 12.Tang TS, Solomon LJ, McCracken LM. Cultural barriers to mammography, clinical breast exam, and breast self-exam among Chinese-American women 60 and older. Prev Med. 2000;31(5):575–83. doi: 10.1006/pmed.2000.0753. [DOI] [PubMed] [Google Scholar]
- 13.Tu SP, Yasui Y, Kuniyuki AA, Schwartz SM, Jackson JC, Hislop TG, et al. Mammography screening among Chinese American women. Cancer. 2003;97(5):1293–302. doi: 10.1002/cncr.11169. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Hiatt RA, Pasick RJ, Perez-Stable E, McPhee SJ, Engelstad L, Lee M, et al. Pathways to early detection in the multiethnic population of the San Francisco Bay area. Health Educ Q Suppl. 1996;23:S10–S27. doi: 10.1177/109019819602301S03. [DOI] [Google Scholar]
- 15.Tu SP, Taplin SH, Barlow WE, Boyko EJ. Breast cancer screening by Asian-American women in a managed care environment. Am J Prev Med. 1999;17(1):55–61. doi: 10.1016/S0749-3797(99)00043-4. [DOI] [PubMed] [Google Scholar]
- 16.Statistics Canada. Census Recensement 96. 1996. Available on-line at https://doi.org/www.statcan.ca/eng-lish/census96/feb17/vmbc.htm
- 17.Hislop TG, Schwartz SM, Taylor V, Jackson JC, Tu SP. Identification of Chinese Subjects for Etiological and Cancer Control Research: Description of Sampling Methods Based Upon Surnames. New Orleans: North American Association of Central Cancer Registries Annual Meeting; 2000. p. 87. [Google Scholar]
- 18.Eyton J, Neuwirth G. Cross-cultural validity: Ethnocentrism in health studies with special reference to the Vietnamese. Soc Sci Med. 1984;18(5):447–53. doi: 10.1016/0277-9536(84)90061-3. [DOI] [PubMed] [Google Scholar]
- 19.McPhee SJ, Bird JA, Ha NT, Jenkins C, Fordham D, Le B. Pathways to early cancer detection for Vietnamese women: Suc Khoe La Vang! (Health is Gold!) Health Educ Q Suppl. 1996;23:S60–S75. doi: 10.1177/109019819602301S06. [DOI] [Google Scholar]
- 20.Curry SJ, Emmons K. Theoretical models for predicting and improving compliance with breast cancer screening. Ann Behav Med. 1994;16:302–16. [Google Scholar]
- 21.Green L, Krueler M. Health Promotion Planning: An Educational and Environmental Approach. Palo Alto: Mayfield; 1991. Applications of PRECEDE-PROCEED in Community Settings. [Google Scholar]
- 22.Jackson JC, Do H, Chitnarong K, Tu SP, Marchand A, Hislop TG, et al. Development of cervical cancer control interventions for Chinese immigrants. J Immigrant Health. 2002;4(3):147–57. doi: 10.1023/A:1015650901458. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Screening Mammography Program of British Columbia. Information about screening mam-mogram for women in their 50s, 60s and 70s. Vancouver: SMPBC; 2001. [Google Scholar]
- 24.Rosner B. Fundamentals of Biostatistics. Fifth ed. Boston: Duxbury; 2000. [Google Scholar]
- 25.Kleinbaum DG. Logistic Regression: A Self-learning Text. New York: Springer-Verlag; 1994. [Google Scholar]
- 26.Katz SJ, Larson EB, LoGerfo JP. Trends in the utilization of mammography in Washington State and British Columbia: Relation to stage of diagnosis and mortality. Med Care. 1992;30(4):320–28. doi: 10.1097/00005650-199204000-00003. [DOI] [PubMed] [Google Scholar]
- 27.Katz SJ, Hislop TG, Thomas DB, Larson EB. Delay from symptom to diagnosis and treatment of breast cancer in Washington State and British Columbia. Med Care. 1993;31(3):264–68. doi: 10.1097/00005650-199303000-00007. [DOI] [PubMed] [Google Scholar]
- 28.Katz SJ, Hofer TP. Socioeconomic disparities in preventive care persist despite universal coverage. Breast and cervical cancer screening in Ontario and the United States. JAMA. 1994;272(7):530–34. doi: 10.1001/jama.1994.03520070050037. [DOI] [PubMed] [Google Scholar]
- 29.Katz SJ, Zemencuk JK, Hofer TP. Breast cancer screening in the United States and Canada, 1994: Socioeconomic gradients persist. Am J Public Health. 2000;90(5):799–803. doi: 10.2105/AJPH.90.5.799. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Mandelblatt JS, Gold K, O’Malley AS, Taylor K, Cagney K, Hopkins JS, et al. Breast and cervix cancer screening among multiethnic women: Role of age, health, and source of care. Prev Med. 1999;28(4):418–25. doi: 10.1006/pmed.1998.0446. [DOI] [PubMed] [Google Scholar]
- 31.Hiatt RA, Pasick RJ, Stewart S, Bloom J, Davis P, Gardiner P, et al. Community-based cancer screening for underserved women: Design and baseline findings from the Breast and Cervical Cancer Intervention Study. Prev Med. 2001;33(3):190–203. doi: 10.1006/pmed.2001.0871. [DOI] [PubMed] [Google Scholar]
- 32.O’Malley MS, Earp JA, Hawley ST, Schell MJ, Mathews HF, Mitchell J. The association of race/ethnicity, socioeconomic status, and physician recommendation for mammography: Who gets the message about breast cancer screening? Am J Public Health. 2001;91(1):49–54. doi: 10.2105/AJPH.91.1.49. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Stein JA, Fox SA, Murata PJ. The influence of ethnicity, socioeconomic status, and psychological barriers on use of mammography. J Health Soc Behav. 1991;32(2):101–13. doi: 10.2307/2137146. [DOI] [PubMed] [Google Scholar]
- 34.Grana G. Ethnic differences in mammography use among older women: Overcoming the barriers. Ann Intern Med. 1998;128(9):773–75. doi: 10.7326/0003-4819-128-9-199805010-00013. [DOI] [PubMed] [Google Scholar]
- 35.Qureshi M, Thacker HL, Litaker DG, Kippes C. Differences in breast cancer screening rates: An issue of ethnicity or socioeconomics? J Womens Health Gend Based Med. 2000;9(9):1025–31. doi: 10.1089/15246090050200060. [DOI] [PubMed] [Google Scholar]
- 36.Maxwell AE, Bastani R, Warda US. Mammography utilization and related attitudes among Korean-American women. Women Health. 1998;27(3):89–107. doi: 10.1300/J013v27n03_07. [DOI] [PubMed] [Google Scholar]
- 37.McPhee SJ, Stewart S, Brock KC, Bird JA, Jenkins CN, Pham GQ. Factors associated with breast and cervical cancer screening practices among Vietnamese American women. Cancer Detect Prev. 1997;21(6):510–21. [PubMed] [Google Scholar]
- 38.Pham CT, McPhee SJ. Knowledge, attitudes, and practices of breast and cervical cancer screening among Vietnamese women. J Cancer Educ. 1992;7(4):305–10. doi: 10.1080/08858199209528187. [DOI] [PubMed] [Google Scholar]
- 39.Mo B. Modesty, sexuality, and breast health in Chinese-American women. West J Med. 1992;157(3):260–64. [PMC free article] [PubMed] [Google Scholar]
- 40.Nguyen TT, McPhee SJ, Somkin CP, Vo P, Nguyen BH, Shema SJ. J Gen Intern Med. 2001. How valid are PAP smear and mammogram self-reports in a multiethnic population? [Google Scholar]