Breast cancer screening practices of African migrant women in Australia: a descriptive cross-sectional study

Decolonising medical knowledge - The case of breast cancer and ethnicity in the UK

National and global efforts have led to significant improvements in breast health and diagnosis, globally (Lukong, 2017). These achievements, however, are not even. Focusing on the case of breast cancer in the UK, we argue that enduring forms of medical racism leave Black women more vulnerable to advanced forms of the disease, explaining higher mortality rates and later-stage diagnosis. In particular, we show how a lack of dedicated policy, inadequate data collection, and a lack of representation conspire to place Black women at additional and unnecessary risk of worse breast cancer outcomes. We thus propose key recommendations to address the ethnic disparities in and make steps to decolonise breast cancer care. These are early screening for at-risk groups, community-led interventions, and more and better representation of Black women and their risks in breast cancer resources.

Beyond language: Motivators and barriers to breast cancer screening among Korean-speaking women in Sydney Metropolitan, Australia

BACKGROUND

There are persistent disparities in breast screening participation rates between Australian-born women and women from culturally and linguistically diverse (CALD) backgrounds. Cancer Institute NSW statistics from 2015 show Korean speaking women had the second lowest breast screening participation rates when compared across all language groups.

OBJECTIVE

The study aimed to gain a better understanding of the motivators and barriers associated with participation in breast cancer screening among women from a Korean background living in the Sydney metropolitan area.

METHODS

Semi-structured individual interviews (n = 32) and small focus groups (n = 28) were conducted. Data from interviews and focus group discussions were analysed using thematic analysis.

RESULTS

The findings highlight the barriers to access breast screening services extend beyond language to include perception, a lack of knowledge and understanding of the services offered, unfamiliarity with the Australian healthcare system and distrust in breast screening services.

CONCLUSION

Supporting Korean women to understand and navigate the Australian healthcare system plays an important role in increasing breast screening participation rates. Key strategies to provide this support include the delivery of culturally sensitive health promotion and community engagement as well as the provision of translated health information.

Acculturation Strategies and Pap Screening Uptake among Sub-Saharan African Immigrants (SAIs)

Although regular cervical cancer screening can prevent cervical cancer, screening utilization remains low among immigrant population including sub-Saharan African immigrants (SAIs). Acculturation is a complex process, which can lead to adoption of positive or negative health behaviors from the dominant culture. Acculturation strategies are the varying ways in which individuals seek to go about their acculturation by either maintaining or rejecting their own cultural values ip or accepting or rejecting the host culture’s cultural values. Cervical cancer screening behaviors among SAI women may be influenced by their acculturation strategies. We conducted a secondary analysis of data to examine the relationship between acculturation strategies and Pap screening among 99 SAI women recruited from community settings. Data were collected on Pap screening behavior and acculturation strategy. Traditionalists and Integrationists were the dominant acculturation strategies; 32.3% women were Traditionalists and 67.7% Integrationists. From the logistic regression models, Integrationists had seven times the odds of having ever been screened compared to Traditionalists (OR = 7.08, 95% CI = 1.54–28.91). Cervical cancer screening interventions should prioritize Traditionalists for cancer screening. Acculturation strategies may be used to tailor cancer prevention and control for SAIs. More research among a larger SAI women sample is warranted to further our understanding of Pap screening patterns and acculturation strategies.

Associations between breast cancer screening participation and residential area sociodemographic features, geographic accessibility, and features of screening venue location in Greater Sydney, Australia

Breast cancer screening (BCS) participation rates are often suboptimal and vary geographically. Environmental features may influence BCS participation, but few studies have assessed this relationship. This study assessed the associations between BCS participation, residential area sociodemographic characteristics, distance to BCS venue, and venue location attributes. Data for 384,433 women residing in Greater Sydney, Australia, invited to BCS during 2011-2014 were spatially joined to their state suburb (SSC) (n = 800). SSC sociodemographic measures included women's median age, proportion women speaking English at home, full-time employed, and university educated; and proportion dwellings with motor-vehicles. Road network distance was calculated to each BCS venue. BCS venues were coded as co-located with bus-stop, train-station, hospital, general practitioner (GP), and shop. Hot spots were calculated to quantify spatial clustering of BCS participation. Multilevel logistic models were used to estimate the associations between environmental predictors and BCS participation, accounting for SSC-level clustering. BCS participation was 53.9% and spatially clustered. BCS was positively associated with SSC-level median age for women, proportions women speaking English and university educated, and dwellings with motor-vehicles. Distance to venue was inversely associated with BCS. Venue co-location with GP was positively associated and co-location with bus-stop, train-station, and shop, hospital were negatively associated with BCS. Residential sociodemographic features, geographic access, and venue location attributes are associated with BCS participation. These findings implicate the relevance of social and built environmental factors to programmatic aims to raise BCS participation. Additional research on venue location features is required to understand where best to site BCS venues.

Barriers and Facilitators of Breast Cancer Screening amongst Culturally and Linguistically Diverse Women in South Western Sydney: A Qualitative Explorative Study

Breast cancer is the most common cause of cancer amongst Australian women and the second most common cause of cancer mortality. Despite the proven effectiveness of early intervention, screening rates remain subpar across many regions in New South Wales (NSW). Screening rates are particularly low within the culturally and linguistically diverse (CALD) area of South Western Sydney (SWS). The objective of this study was to qualitatively explore barriers and facilitators to breast screening from the perspectives of CALD women from SWS. CALD women aged ≥40 who resided in SWS were invited to participate in a semi-structured interview to explore barriers and facilitators to breast cancer screening. Interviews were recorded, transcribed verbatim and analysed thematically to identify recurring patterns in the data. Sixteen women from CALD backgrounds participated. Women in this study reported absence of symptoms, fatalistic beliefs and embarrassment during the procedure to be the primary reasons for reluctance to screen. Lack of general practitioner (GP) endorsement, transport issues and pain associated with the procedure were also reported as additional barriers to screening. Common facilitators to screening included encouragement from family and friends, family history of cancer and media adverts. CALD women have distinctive barriers to mammography, which lead to poor breast screening participation rates. Opportunistic health promotion in this area is warranted and may lead to better health outcomes amongst this population.

Equity across the cancer care continuum for culturally and linguistically diverse migrants living in Australia: a scoping review

International evidence suggests migrants experience inequitable access, outcomes and treatment quality across the cancer care continuum. There is currently limited research assessing equity across the cancer care continuum for culturally and linguistically diverse migrants living in Australia. A detailed protocol and search strategy were developed and used to identify all relevant literature, utilising the Joanna Briggs Institute Reviewer’s Manual. Systematic searching was conducted via multiple databases and identified studies were screened against pre-identified inclusion and exclusion criteria. 71 studies met the inclusion criteria for analysis. Most studies examined cancer detection via screening. Very few studies examined cancer prevention, diagnosis, treatment or palliative care. Most studies focused on patient-sided barriers to care and there was a paucity of information regarding institutional barriers to health. Cancer-related outcomes were seldom examined, and most studies were qualitative or behavioral analysis. Results highlighted significant communication issues spanning the cancer care continuum and a context of inadequate support for both patients and clinicians. There is a demonstrable need to examine equity in access and outcomes for culturally and linguistically diverse cancer populations. This requires the identification of cancer-related disparities and an examination of institutional barriers to care. Through addressing this dearth of information, future research and health policy can support the operationalisation of health equity.

Social inequalities in breast cancer screening: evaluating written communications with immigrant Haitian women in Montreal

Background

The province of Quebec (Canada) has implemented a breast cancer screening program to diagnose this cancer at an early stage. The strategy is to refer women 50 to 69 years old for a mammogram every two years by sending an invitation letter that acts as a prescription. Ninety per cent (90%) of deaths due to breast cancer occur in women aged 50 and over. Numerous studies have shown social inequalities in health for most diseases. With breast cancer, a significant paradox arises: its incidence is lower among disadvantaged women and yet, more of them die from this disease. The health care system might play a role in this inequality. The scientific literature documents the potential for creating such inequalities when prevention does not consider equity among social groups. Immigrant women are often disadvantaged. They die of breast cancer more than non-immigrants. Studies attribute this to late-stage diagnosis due to poor adherence to mammography screening programs.

Purpose of the study

The main objective of our research is to assess how Haitian immigrant women in Montreal are reached by the Quebec Breast Cancer Screening Program, and specifically how they perceive the mammogram referral letter sent by the program.

Methods

The study uses a two-step qualitative method: i) In-depth interviews with influential community workers to identify the most relevant issues; ii) Focus groups with disadvantaged women from Montreal’s Haitian community.

Results

A mammogram referral letter from the Breast Cancer Screening Program may be a barrier to compliance with mammography by underprivileged Haitian women in Montreal. This might be attributable to a low level of literacy, poor knowledge of the disease, and lack of financial resources.

Conclusion

Barriers may be underestimated in underprivileged immigrant and non-immigrant communities. A preventive strategy must be adapted to different sub-groups and must also take into account lower literacy levels. To increase mammography uptake, it is crucial that the benefits of prevention be clearly identified and described in understandable terms. Finally, economic access to follow-up measures should be considered.

Health Literacy Environment of Breast and Cervical Cancer among Black African Women Globally: A Systematic Review Protocol of Mixed Methods

Adequate health literacy is a necessity to enable effective decision making to seek, access and utilise appropriate health care service. Evidence exists indicating a low level of general health literacy among Black African women, especially those with a refugee background. Breast and cervical are the most common cancers, with Black African women or women with African ethnicity being disproportionately overrepresented. The level of health literacy specific to breast and cervical cancer among Black African women, especially those with a refugee background, has not been reviewed systematically. The present study describes a protocol for a systematic review of the available evidence on the level of health literacy specific to breast and cervical cancer among Black African women globally. We will perform a systematic review of the available quantitative and qualitative studies. The search will include studies that describe the level of health literacy specific to breast and cervical cancer among Black African women. We will conduct a preliminary search on Google scholar to build the concepts for search terms, and a full search strategy using the identified concepts and keywords across four databases namely PubMed, SCOPUS, CINAHL and Web of Sciences. We will use Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to schematically present the search strategy. We will use the standardized Joanna Briggs Institute quality appraisal and selection tool to recruit studies, and the data extraction tool to synthesise the information extracted from the recruited studies. We will be guided by socioecological theory and Indigenous epistemology to synthesise the non-quantifiable information thematically, and pool the quantitative information using meta-analysis, based on the availability of information.

Psychometric properties of the Breast Cancer Awareness Measurement among Chinese women: a cross-sectional study

OBJECTIVES

To perform the cross-cultural adaption of the Breast Cancer Awareness Measurement (BCAM) and to test its psychometric properties among Chinese women.

DESIGN

This is a cross-sectional study.

SETTINGS

This study was conducted in communities, schools and institutions in Changchun, Jilin Province, China.

PARTICIPANTS

A total of 328 women voluntarily participated in and completed the Chinese version of the BCAM (C-BCAM), resulting in an effective response rate of 91.1%.

PRIMARY AND SECONDARY OUTCOME MEASURES

Psychometric properties, including item analysis (the extreme group comparison and item-total correlations), content validity (item-level content validity index (I-CVI) and scale-level content validity index (S-CVI)), construct validity (exploratory factor analysis (EFA) and confirmatory factor analysis (CFA)) and internal consistency (Cronbach's α and test-retest reliability), were measured.

RESULTS

The C-BCAM has excellent internal consistency (Cronbach's α=0.90), with alpha coefficients of 0.88, 0.84 and 0.94 for its three domains. The test-retest reliability coefficient was 0.72. The I-CVI ranged from 0.86 to 1.00, and the S-CVI was 0.92. CFA showed that the three-factor model explained 51.56% of the total variance, with a good model fit (likelihood ratio χ²/df=1.86, incremental fit index=0.94, comparative fit index=0.94, goodness-of-fit index=0.84, adjusted goodness-of-fit index=0.80, standardised root mean square error of approximation=0.06 and root mean square residual=0.05).

CONCLUSIONS

The C-BCAM has satisfactory validity and reliability and is a culturally appropriate and reliable tool for evaluating breast cancer awareness among Chinese women. This reliable instrument can help researchers and health professionals evaluate women's knowledge about the symptoms and risk factors of breast cancer and identify their barriers to seeking medical help. It also helps healthcare providers identify women with poor breast cancer awareness and encourage them to perform screening practice.

Knowledge and Attitudes about Breast Cancer among Women: A Wake-Up Call in Nigeria

BACKGROUND:

Preventable deaths resulting from the scourge of breast cancer has become alarming and worrisome in many societies in developing countries, including Nigeria. Of much concern is the fact that breast cancer has continued to claim the precious lives of young, middle-aged, old, educated and non-educated women irrespective of their religion, socio-economic background and socio-demographic characteristics.

AIM:

This study attempts to ascertain the knowledge and attitudes of women to breast cancer in Ogun State, Nigeria.

METHODS:

The study adopts both primary and secondary data sources to examine the level of knowledge and attitude of women towards breast cancer with the view of suggesting probable solutions and recommendations for policy.

RESULTS:

The result indicates that the awareness about breast cancer is overwhelming but only few women know about mammography; women in older age are 0.193 times less likely to attend breast cancer screening (p=0.000). Older women with secondary education that are either self-employed outside the home or full-time housewives are unfavourably disposed to breast cancer screening.

CONCLUSION:

The authors recommend that concerned stakeholders in the health sector and policy decision makers should intensify action on cancer programmes and campaigns that could target older women especially housewives and women in middle level education.

Expression of Fibroblast Growth Factor 5 (FGF5) and Its Influence on Survival of Breast Cancer Patients

BACKGROUND The clinical outcome of patients with breast cancer (BC) remains poor. MATERIAL AND METHODS We analyzed BC microarray studies GSE37751, GSE7390, and GSE21653 to investigate the expression of FGF5 gene between BC patients and their normal counterparts and the relationship between FGF5 expression and age, tumor size, histopathological grading, estrogen receptors, clinical risk group according to St Gallen criteria, clinical risk group according to NPI criteria, clinical risk group according to Veridex signature, distant metastasis-free survival (DMFS), time to distant metastasis (TDM), disease-free survival (DFS), and overall survival (OS) of BC patients. Gene set enrichment analysis (GSEA) was used to investigate the exact mechanisms. RESULTS FGF5 expression was significantly upregulated in BC patients relative to that in normal controls (P<0.0001). BC patients in the FGF5 low-expression group were correlated with better clinical characteristics, including tumor size, histopathological grading, estrogen receptors, clinical risk group according to St Gallen criteria, NPI criteria and Veridex signature, DMFS, TDM, and DFS compared with those in the FGF5 high-expression cohort. The result of GSEA indicated that FGF5 inhibits the proliferation of BC cells via ultraviolet response and TGF-b signaling. Quantitative PCR verified that FGF5 was overexpressed in patients with BC. CONCLUSIONS Our results suggest that FGF5 is an independent protective factor for BC patients.