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Abraham O, Agoke A, Sanuth K, Fapohunda A, Ogunsanya M, Piper M, Trentham-Dietz A. Need for Culturally Competent and Responsive Cancer Education for African Immigrant Families and Youth Living in the United States. JMIR Cancer 2024; 10:e53956. [PMID: 38447129 PMCID: PMC10955401 DOI: 10.2196/53956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/23/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Cancer prevalence data for Black Americans is monolithic and fails to consider the diverse cultures and backgrounds within that community. For instance, African immigrants constitute a meaningful proportion of the foreign-born Black immigrants in the United States (42%), but the prevalence of cancer in the African immigrant community itself is unknown. Therefore, without accurate cancer prevalence data, it is impossible to identify trends and other key factors that are needed to support the health of African immigrants and their children. Moreover, it is impossible to understand how the culture and language of subgroups influence their cancer-related health behavior. While research in this area is limited, the existing literature articulates the need for culturally responsive and culturally tailored cancer education for African immigrants and their adolescent children, which is what we advocate for in this viewpoint paper. Existing projects demonstrate the feasibility of culturally responsive programming for adults; however, few projects include or focus on adolescents or children born to African immigrants. To best meet the needs of this understudied community, researchers must use culturally competent interventions alongside familiar, usable media. For adolescents, technology is ubiquitous thus, the creation of a culturally tailored digital intervention has immense potential to improve cancer awareness and prevention for youth and their community. More research is needed to address many of the existing research gaps and develop a rich understanding of the unique experience of cancer among African immigrant families that can be used to inform intervention development. Through this viewpoint, we review the current state of cancer-related research among African immigrant families in the United States. In this paper, we acknowledge the current knowledge gaps and issues surrounding measurement and then discuss the factors relevant to designing an educational intervention targeted at African immigrants and the role of African immigrant youth.
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Affiliation(s)
- Olufunmilola Abraham
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States
| | - Adeola Agoke
- African Cultural Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Kazeem Sanuth
- National African Language Resource Center, Indiana University Bloomington, Bloomington, IN, United States
| | - Abimbola Fapohunda
- Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Motolani Ogunsanya
- College of Pharmacy, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
| | - Megan Piper
- Department of Medicine and Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Amy Trentham-Dietz
- Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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Pesapane F, Tantrige P, Rotili A, Nicosia L, Penco S, Bozzini AC, Raimondi S, Corso G, Grasso R, Pravettoni G, Gandini S, Cassano E. Disparities in Breast Cancer Diagnostics: How Radiologists Can Level the Inequalities. Cancers (Basel) 2023; 16:130. [PMID: 38201557 PMCID: PMC10777939 DOI: 10.3390/cancers16010130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Access to medical imaging is pivotal in healthcare, playing a crucial role in the prevention, diagnosis, and management of diseases. However, disparities persist in this scenario, disproportionately affecting marginalized communities, racial and ethnic minorities, and individuals facing linguistic or cultural barriers. This paper critically assesses methods to mitigate these disparities, with a focus on breast cancer screening. We underscore scientific mobility as a vital tool for radiologists to advocate for healthcare policy changes: it not only enhances diversity and cultural competence within the radiology community but also fosters international cooperation and knowledge exchange among healthcare institutions. Efforts to ensure cultural competency among radiologists are discussed, including ongoing cultural education, sensitivity training, and workforce diversification. These initiatives are key to improving patient communication and reducing healthcare disparities. This paper also highlights the crucial role of policy changes and legislation in promoting equal access to essential screening services like mammography. We explore the challenges and potential of teleradiology in improving access to medical imaging in remote and underserved areas. In the era of artificial intelligence, this paper emphasizes the necessity of validating its models across a spectrum of populations to prevent bias and achieve equitable healthcare outcomes. Finally, the importance of international collaboration is illustrated, showcasing its role in sharing insights and strategies to overcome global access barriers in medical imaging. Overall, this paper offers a comprehensive overview of the challenges related to disparities in medical imaging access and proposes actionable strategies to address these challenges, aiming for equitable healthcare delivery.
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Affiliation(s)
- Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (S.P.); (A.C.B.); (E.C.)
| | - Priyan Tantrige
- King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK;
| | - Anna Rotili
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (S.P.); (A.C.B.); (E.C.)
| | - Luca Nicosia
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (S.P.); (A.C.B.); (E.C.)
| | - Silvia Penco
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (S.P.); (A.C.B.); (E.C.)
| | - Anna Carla Bozzini
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (S.P.); (A.C.B.); (E.C.)
| | - Sara Raimondi
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.R.); (S.G.)
| | - Giovanni Corso
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (G.C.); (R.G.); (G.P.)
- Division of Breast Surgery, IEO European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy
- European Cancer Prevention Organization (ECP), 20122 Milan, Italy
| | - Roberto Grasso
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (G.C.); (R.G.); (G.P.)
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (G.C.); (R.G.); (G.P.)
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Sara Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.R.); (S.G.)
| | - Enrico Cassano
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (S.P.); (A.C.B.); (E.C.)
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Williams WM, Fu MR. Understanding Breast Cancer Disparities Affecting Black Women: Obtaining Diverse Perspectives Through Focus Groups Comprised of Patients, Providers, and Others. J Community Health 2023; 48:834-839. [PMID: 37131066 DOI: 10.1007/s10900-023-01227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/04/2023]
Abstract
Black women have the highest death rate from breast cancer and a higher chance of developing breast cancer before the age of 40 than White women. Mammography screening is recommended for early detection which has led to decreased mortality and improved survival. Unfortunately, Black women are less likely to have breast cancer screenings. Environmental justice communities represent place-based structural disparity/racism leading to health inequality. Environmental justice specifically addresses situations where minority or low-income communities bear disproportionately poor human health outcomes and environmental risks. The purpose of this qualitative study was to gain a deep understanding of breast cancer screening disparity from multiple perspectives to enable collective solutions to barriers faced by Black women in an environmental justice community. Data were collected from 22 participants using a focus group approach from Black women with breast cancer (n = 5) and without it (n = 5), healthcare providers (n = 6), and community leaders (n = 6). An iterative and inductive thematic data analysis method was used to analyze data. The themes that emerged from the data included: (1) misconceptions and fear of mammograms; (2) breast cancer screening beyond mammograms; and (3) barriers beyond mammograms. These themes reflected personal, community, and policy barriers leading to breast cancer screening disparity. This study was an initial step to develop multi-level interventions targeting the personal, community, and policy barriers that are needed to advance breast cancer screening equity for Black women living in environmental justice communities.
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Affiliation(s)
- Wanda M Williams
- School of Nursing, University of North Carolina-Greensboro, 1007 Walker Avenue Greensboro, Greensboro, NC, North Carolina, 27412, USA.
| | - Mei Rosemary Fu
- School of Nursing, George Washington University, 1919 Pennsylvania Ave. NW Suite 500, Washington, D.C, 20006, USA
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Mehta TS, Thompson J, Applegate JM, Wahab RA. Cultural Competence in the Care of LGBTQ+ Patients: A Primer for Breast/Chest Centers. JOURNAL OF BREAST IMAGING 2023; 5:473-479. [PMID: 38416897 DOI: 10.1093/jbi/wbad012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Indexed: 03/01/2024]
Abstract
The number of individuals identifying as lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) has doubled over the past 10 years, and this figure continues to rise. The LGBTQ+ community is diverse, encompassing a vast array of differences in gender identity and sexual orientation. Additionally, it is inclusive of people from all races, ethnicities, religions, and socioeconomic backgrounds. This intersectionality of identities and experiences impacts both access to health care and its delivery. Barriers to care for this population are multifactorial and include stigma, discrimination, bias, limited role models, issues with insurance coverage, lack of education and training for health care providers, and lack of research on LGBTQ+ health-related issues. Specific to breast cancer, the screening recommendations for this group are influenced not only by risk but also by gender-affirming hormonal and surgical therapies. This article will provide an overview of the LGBTQ+ population, review breast cancer screening compliance and recommendations, summarize the multitude of health disparities, and offer potential interventions to improve care delivery at the individual, facility, organizational, and health policy levels.
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Affiliation(s)
- Tejas S Mehta
- UMass Memorial Medical Center, Department of Radiology, Worcester, MA, USA
| | | | - Julia M Applegate
- The Ohio State University, Department of Women's, Gender and Sexuality Studies, Columbus, OH, USA
| | - Rifat A Wahab
- University of Cincinnati Medical Center, Department of Radiology, Cincinnati, OH, USA
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Sharp L, Dodlek N, Willis D, Leppänen A, Ullgren H. Cancer Prevention Literacy among Different Population Subgroups: Challenges and Enabling Factors for Adopting and Complying with Cancer Prevention Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105888. [PMID: 37239613 DOI: 10.3390/ijerph20105888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
It is estimated that 40% of the cancer cases in Europe could be prevented if people had better information and tools to make healthier choices and thereby reduce some of the most important cancer risk factors. The aim of this study is to gain knowledge and understanding about cancer prevention literacy among people with intellectual disabilities, immigrants, young people and young cancer survivors. In this qualitative study, we conducted six online focus-group interviews, including forty participants, to explore the cancer prevention literacy of four population subgroups and determine how cancer prevention recommendations according to the European Code Against Cancer (ECAC) were perceived. The analysis resulted in the following main categories: current health beliefs and their impacts on how the ECAC recommendations were perceived, communication strategies and sources benefiting or hindering cancer prevention information from reaching out, and how vulnerabilities in these subgroups impact cancer prevention literacy. To improve cancer prevention literacy in Europe, more attention is needed this topic to overcome barriers among different population subgroups. Recommendations include improved and adapted cancer prevention information, support to individuals, as well as societal support, such as easy-access screening and vaccination programmes and regulations related to tobacco, alcohol, and diet.
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Affiliation(s)
- Lena Sharp
- Regional Cancer Centre, Stockholm-Gotland, SE-10425 Stockholm, Sweden
- Department of Nursing, Umeå University, SE-90187 Umeå, Sweden
| | - Nikolina Dodlek
- Department for Oncology, University Hospital Center Osijek, 31000 Osijek, Croatia
- Department of Nursing, Cyprus University of Technology, Limassol 3036, Cyprus
- Nursing and Palliative Care, Faculty for Medicine and Dental Health, 31000 Osijek, Croatia
| | - Diane Willis
- School of Health & Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | - Arja Leppänen
- Regional Cancer Centre, Stockholm-Gotland, SE-10425 Stockholm, Sweden
| | - Helena Ullgren
- Department of Nursing, Umeå University, SE-90187 Umeå, Sweden
- ME Head & Neck, Lung & Skin Cancer, Karolinska Comprehensive Cancer Center, SE-17176 Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, SE-17177 Stockholm, Sweden
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Vang S, Margolies LR, Jandorf L. Screening Mammogram Adherence in Medically Underserved Women: Does Language Preference Matter? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1076-1082. [PMID: 33169336 PMCID: PMC8106692 DOI: 10.1007/s13187-020-01922-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 06/11/2023]
Abstract
This study examines the relationship between language preference and screening mammogram adherence in medically underserved women in New York City. A survey was conducted with 518 women age 40 and over attending breast health education programs in English, Spanish, Chinese (Mandarin/Cantonese), and French. Women who preferred Chinese were 53% less likely to have had a mammogram within the past year compared to women who preferred English (p < .01). Women age 75 and older (p < .0001) and those without insurance (p < .05) were also found to be significantly less likely to have had a screening mammogram compared to women ages 55-74 and those with private insurance, respectively. This research indicates medically underserved women who prefer a non-English language may benefit from linguistically appropriate interventions to improve screening mammogram adherence. Future research should examine appropriateness of breast cancer screening for women age 75 and older and explore ways to improve screening mammogram use in the uninsured population.
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Affiliation(s)
- Suzanne Vang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1077, New York, NY, 10029, USA.
| | - Laurie R Margolies
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lina Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Patel MM, Parikh JR. Patient Diversity in Breast Imaging: Barriers and Potential Solutions. JOURNAL OF BREAST IMAGING 2021; 3:98-105. [PMID: 38424834 DOI: 10.1093/jbi/wbaa092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Indexed: 03/02/2024]
Abstract
Recent reports have highlighted disparities in breast cancer care related to patient diversity. Breast radiologists represent the face of breast imaging and are key players in advocating for patients to reduce these disparities. Diversity-related barriers for breast imaging patients, as they journey from screening to survivorship, include impediments to access and quality of care, gaps in communication, and lack of knowledge in both providers and patients. Potential strategies for overcoming these specific barriers include "culturally tailored" nurse navigators, mobile mammography, improved communication, patient and provider education, and breast radiologist involvement in advocacy efforts promoting diversity. As current trends in recommendations and guidelines for breast imaging include more numerous and advanced imaging modalities, it is important to acknowledge and address diversity-related disparities.
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Affiliation(s)
- Miral M Patel
- The University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
| | - Jay R Parikh
- The University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
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