Knowledge of Breast Cancer Screening Among Immigrant Women in the United States

Qiuping (Pearl) Zhou, RN, PhD¹, Janet Hooper, RNC, BSN², Karina Jimenez, MSW¹, and Kirsten Edmiston, MD³. (1) Avon-Inova Cares Breast Cancer Network, Women's Services, Inova Fairfax Hospital, Falls Church, VA, USA, (2) OB/GYN/Surgical Clinic, Inova Fairfax Hospital, Falls Church, VA, USA, (3) Cancer Center, Inova Fairfax Hospital, Falls Church, VA, USA

There are striking disparities in breast cancer outcomes between different ethnic groups in the United States. Despite evidence that screening leads to reduced breast cancer mortality, it continues to be underused by minority women, especially new immigrants. For immigrants, lack of awareness/knowledge is a major factor contributing to limited participation in screening services. However, the scope of their knowledge deficiency and factors associated with it are not well documented.

The purposes are 1) to assess knowledge levels of breast cancer screening in low-income immigrant women; and 2) to identify factors associated with their knowledge levels.

This descriptive study included 983 low-income pregnant women attending an OB clinic. Reported birthplaces were Mexico/Central/South America (774), Africa (90) and Asia/Pacific Island (119). We interviewed each woman in a private room prior to an education session to assess her knowledge about 1) risk factors for breast cancer, 2) clinical breast exam, 3) breast self exam and 4) mammography. Coefficient alpha for this four-item tool is 0.86. Demographic and social-economic variables were collected by chart review. We used descriptive statistics, ANOVA, multiple regression, etc. to analyze data.

Knowledge about breast cancer screening was extremely low in immigrant women, 69% to 74% had never heard of mammograms. Compared to U.S. born women with similar medical/social-economic status (n=130), immigrant women reported lower knowledge levels (3.9 vs. 8.7, P<0.001) while there were no significant differences among the immigrant groups. Except for education, which was a common factor, multiple regression with stepwise methods identified different factors contributing to variance in knowledge in different groups.

These findings suggest a pressing need to develop culturally effective education programs to target immigrant women to increase their awareness, thus leading to increased breast cancer screening behaviors. Pregnancy provides an opportunity to break barriers to reach these populations.

Learning Objective #1: demonstrate improved understanding of the scope of knowledge deficiency about breast cancer screening in a vulnerable population - immigrant women.
Learning Objective #2: describe factors related to low knowledge in immigrant women and understand the importance of awareness in the process of behavioral change.