Abstract
Screening mammograms are important to detect breast cancer at earlier and more treatable stages. Immigrant and minority women report low participation rates due to barriers related to cultural beliefs and norms, privacy/modesty, and language. This review examines whether screening mammogram interventions in Canada and other countries with comparable health-care systems have addressed the needs of these women. Our systematic literature search identified studies that focused on increasing screening mammogram participation among immigrant and/or minority women. We used the Health Belief Model and the PRECEDE-PROCEED Model to guide our critical synthesis of the reviewed interventions and the recommendations for the future. Eight studies met the search criteria. Overall, interventions showed some increase in mammogram participation rates. The barriers targeted were relatively similar across studies and there was a focus on increasing cues to screening. This review illustrates that it is essential to develop and implement programs to overcome the unique barriers to screening mammography if we are to increase participation among immigrants and minority women. We suggest other potentially effective health promotion strategies as a starting point for discussion and future research.
Similar content being viewed by others
Notes
American studies were excluded because due to the USA’s privatized health care system, issues surrounding health insurance, cost of screening, and income, which have been reported to be associated with utilization of health services and mammograms in the USA [50], [61] would interfere with the generalizability to the Canadian context. In addition, much of the mammogram participation in the USA occurs via opportunistic screening, whereas Canada and other Westernized countries such as the United Kingdom and Australia have implemented organized screening programs to complement or gradually replace opportunistic screening [62]. Studies from non-Westernized countries were also excluded, because it was concluded that it would be important to highlight the difficulties immigrant and minority women face in screening participation in primarily Caucasian-populated/Westernized countries.
We excluded anecdotal descriptive reports because of possible problems with analysis in terms of the reporting of study designs, statistical analyses, and participation rates.
References
WHO. Breast cancer: prevention and control. Retrieved on April 11, 2011 from: http://www.who.int/cancer/detection/breastcancer/en/index1.html.
Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian cancer statistics 2011. In. Toronto, ON: Canadian Cancer Society; 2011.
Canadian Cancer Society. Breast cancer stats. Retrieved on August 28, 2009 from: http://www.cancer.ca/Canada-wide/About%20cancer/Cancer%20statistics/Stats%20at%20a%20glance/Breast%20cancer.aspx?sc_lang=en.
PHAC. Breast cancer. Retrieved on April 11, 2011 from: http://www.phac-aspc.gc.ca/cd-mc/cancer/breast_cancer-cancer_du_sein-eng.php.
PHAC. Progress report on cancer control in Canada. Retrieved on October 22, 2008 from: http://www.phac-aspc.gc.ca/publicat/prccc-relccc/chap_4-eng.php?option=print.
de Waard F, Collette HJ, Rombach JJ, Baanders-van Halewijn EA, Honing C. The DOM project for the early detection of breast cancer, Utrecht, The Netherlands. J Chronic Dis. 1984;37:1–44.
Sarkeala T, Heinavaara S, Anttila A. Organised mammography screening reduces breast cancer mortality: a cohort study from Finland. Int J Cancer. 2008;122:614–9.
Taylor R, Morrell S, Estoesta J, Brassil A. Mammography screening and breast cancer mortality in New South Wales, Australia. Cancer Causes Control. 2004;15:543–50.
Shapiro S, Venet W, Strax P, Venet L. Current results of the breast cancer screening randomized trial: The Health Insurance Plan (HIP) of Greater New York Study. In: Day NE, editor. Miller AB: screening for breast cancer. Toronto: Hans Huber Publishers; 1988. p. 3–15.
Maxwell CJ, Bancej CM, Snider J. Predictors of mammography use among Canadian women aged 50–69: findings from the 1996/97 National Population Health Survey. CMAJ. 2001;164:329–34.
Kwok C, Sullivan G. The concepts of health and preventive health practices of Chinese Australian women in relation to cancer screening. J Transcult Nurs. 2007;18:118–26.
Maxwell CJ, Kozak JF, Desjardins-Denault SD, Parboosingh J. Factors important in promoting mammography screening among Canadian women. Can J Public Health. 1997;88:346–50.
Fox SA, Siu AL, Stein JA. The importance of physician communication on breast cancer screening of older women. Arch Intern Med. 1994;154:2058–68.
Aroian KJ. Immigrant women and their health. Annu Rev Nurs Res. 2001;19:179–226.
Fowler N. Providing primary health care to immigrants and refugees: The North Hamilton experience. CMAJ. 1998;159:388–91.
Gentleman JF, Lee J. Who doesn’t get a mammogram? Health Rep. 1997;9:19–28.
Shields M, Wilkins K. An update on mammography use in Canada. Health Rep. 2009;20:7–19.
Kliewer EV, Smith KR. Breast cancer mortality among immigrants in Australia and Canada. JNCI. 1995;87:1154–61.
Luo W, Birkett NJ, Ugnat AM, Mao Y. Cancer incidence patterns among Chinese immigrant populations in Alberta. J Immigr Health. 2004;6:41–8.
Tatla RK, Paszat LF, Bondy SJ, Chen Z, Chiarelli AM, Mai V. Socioeconomic status & returning for a second screen in the Ontario breast screening program. Breast. 2003;12:237–46.
Donnelly TT, McKellin W, Hislop G, Long B. Socioeconomic influences on Vietnamese-Canadian women’s breast and cervical cancer prevention practices: a social determinant’s perspective. Soc Work Public Health. 2009;24:454–76.
Stamler LL, Thomas B, Lafreniere K. Working women identify influences and obstacles to breast health practices. Oncol Nurs Forum. 2000;27:835–42.
Achat H, Close G, Taylor R. Who has regular mammograms? Effects of knowledge, beliefs, socioeconomic status, and health-related factors. Prev Med. 2005;41:312–20.
Schofield PE, Cockburn J, Hill DJ, Reading D. Encouraging attendance at a screening mammography programme: determinants of response to different recruitment strategies. J Med Screen. 1994;1:144–9.
Hammond JA, Stewart M. Female patients’ attitudes to mammography screening. Can Fam Physician. 1994;40:451–5.
Kung EYL, Chan A, Chong Y, Pham T, Hsu-Hage BHH. Promoting breast screen to Melbourne Chinese women using ethnic-specific health promotion strategies. Retrieved on November 6, 2008 from: http://rhpeo.net/ijhp-articles/1997/3/index.htm.
Raja-Jones H. Breast screening and ethnic minority women: a literature review. Br J Nurs. 1999;8:1284–8.
Chiu LF. Straight talking: communicating breast screening information in primary care. Leeds: Nuffield Institute for Health; 2002.
Choudhry UK, Srivastava R, Fitch MI. Breast cancer detection practices of South Asian women: knowledge, attitudes, and beliefs. Oncol Nurs Forum. 1998;25:1693–701.
Munn EM. Nonparticipation in mammography screening: apathy, anxiety or cost? N Z Med J. 1993;106:284–6.
Bottorff JL, Johnson JL, Bhagat R, Grewal S, Balneaves LG, Clarke H, et al. Beliefs related to breast health practices: the perceptions of South Asian women living in Canada. Soc Sci Med. 1998;47:2075–85.
Hoare TA, Johnson CM, Gorton R, Alberg C. Reasons for non-attendance for breast screening by Asian women. Health Educ J. 1992;51:157–61.
McAllister G, Bowling A. Attitudes to mammography among women in ethnic minority groups in three areas of England. Health Educ J. 1993;52:217–20.
Meana M, Bunston T, George U, Wells L, Rosser W. Influences on breast cancer screening behaviors in Tamil immigrant women 50 years old and over. Ethn Health. 2001;6:179–88.
Austin LT, Ahmad F, McNally MJ, Stewart DE. Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model. WHI. 2002;12:122–8.
Barter-Godfrey S, Taket A. Understanding women’s breast screening behaviour: a study carried out in South East London, with women aged 50–64 years. Health Educ J. 2007;66:335–46.
Bell TS, Branston LK, Newcombe RG, Barton GR. Interventions to improve uptake of breast screening in inner city Cardiff general practices with ethnic minority lists. Ethn Health. 1999;4:277–84.
Jackson SL, Hislop TG, Teh C, Yasui Y, Tu SP, Kuniyuki A, et al. Screening mammography among Chinese Canadian women. Can J Public Health. 2003;94:275–80.
Qi V, Phillips SP, Hopman WM. Determinants of a healthy lifestyle and use of preventive screening in Canada. BMC Public Health. 2006;6:275–82.
Maclean U, Sinfield D, Klein S, Harnden B. Women who decline breast screening. J Epidemiol Community Health. 1984;38:278–83.
Donnelly TT. Challenges in providing breast and cervical cancer screening services to Vietnamese Canadian women: the healthcare providers’ perspective. Nurs Inq. 2008;15:158–68.
Remennick L. The challenge of early breast cancer detection among immigrant and minority women in multicultural societies. Breast J. 2006;12:S103–10.
Seow A, Straughan PT, Ng EH, Emmanuel SC, Tan CH, Lee HP. Factors determining acceptability of mammography in an Asian population: a study among women in Singapore. Cancer Causes Control. 1997;8:771–9.
Canada Health. Quality determinants of organized breast cancer screening programs in Canada. Ottawa: Health Canada; 2003.
Saldov M. The ethnic elderly: communication barriers to health care. Canadian Social Work Review. 1991;8:269–77.
Weerasinghe S, Mitchell T, Hamilton L, Ragheb M. Equitable access to health care, health promotion, and disease prevention for recent immigrant women living in Nova Scotia, Canada: report on phase 1, fact sheet. Halifax: Maritime Centre of Excellence for Women’s Health; 2000.
George U, Ramkissoon S. Race, gender, and class: interlocking oppressions in the lives of South Asian women in Canada. Affilia. 1998;13:102–19.
Meleis AI, Hatter-Pollard M. Arab Middle Eastern American women: Stereotyped, invisible, but powerful. In: Adams DL, editor. Health issues for women of color: a cultural diversity perspective. Thousand-Oaks, CA: Sage Publications; 1995. p. 133–63.
Watts T, Merrell J, Murphy F, Williams A. Breast health information needs of women from minority ethnic groups. J Adv Nurs. 2004;47:526–35.
Ma GX. Between two worlds: the use of traditional and Western health services by Chinese immigrants. J Community Health. 1999;24:421–37.
Bahl V. Cancer and ethnic minorities–the Department of Health’s perspective. BJC. 1996;74:S2–10.
Thomas VN, Saleem T, Abraham R. Barriers to effective uptake of cancer screening among Black and minority ethnic groups. Int J Palliative Nurs. 2005;11(562):564–71.
Ahmad F, Stewart DE. Predictors of clinical breast examination among South Asian immigrant women. J Immigr Health. 2004;6:119–26.
Meadows LM, Thurston WE, Melton C. Immigrant women’s health. Soc Sci Med. 2001;52:1451–8.
Donnelly TT. The health-care practices of Vietnamese-Canadian women: cultural influences on breast and cervical cancer screening. Canadian J Nurs Res. 2006;38:82–101.
Underwood SM, Shaikha L, Bakr D. Veiled yet vulnerable: breast cancer screening and the Muslim way of life. Cancer Pract. 1999;7:285–90.
Yeo SS, Meiser B, Barlow-Stewart K, Goldstein D, Tucker K, Eisenbruch M. Understanding community beliefs of Chinese-Australians about cancer: initial insights using an ethnographic approach. Psychooncology. 2005;14:174–86.
Hoare TA. Breast screening and ethnic minorities. BJC. 1996;74:S38–41.
Bélanger A, Malenfant EC. Population projections of visible minority groups, Canada, provinces and regions: 2001–2017. Ottawa, ON: Demography Division, Statistics Canada; 2005.
Chui T, Tran K, Maheux H. Immigration in Canada: a portrait of the foreign-born population, 2006 Census. Ottawa, ON: Social and Aboriginal Statistics Division, Statistics Canada; 2007.
Urban N, Anderson GL, Peacock S. Mammography screening: how important is cost as a barrier to use? Am J Public Health. 1994;84:50–5.
Miles A, Cockburn J, Smith RA, Wardle J. A perspective from countries using organized screening programs. Cancer. 2004;101:1201–13.
Rosenstock IM. Historical origins of the health belief model. Health Educ Monogr. 1974;2:328–35.
Green LW, Kreuter MW, Deeds SG, Partridge KB. Health education planning: a diagnostic approach. Mountain View, CA: Mayfield; 1980.
Sohl SJ, Moyer A. Tailored interventions to promote mammography screening: a meta-analytic review. Prev Med. 2007;45:252–61.
Black MEA, Frisina A, Hack T, Carpio B. Improving early detection of breast and cervical cancer in Chinese and Vietnamese immigrant women. Oncol Nurs Forum. 2006;33:873–6.
Kernohan EE. Evaluation of a pilot study for breast and cervical cancer screening with Bradford’s minority ethnic women; a community development approach, 1991–1993. BJC. 1996;74:S42–6.
Hoare TA, Thomas C, Biggs A, Booth M, Bradley S, Friedman E. Can the uptake of breast screening by Asian women be increased? A randomized controlled trial of a linkworker intervention. J Public Health Med. 1994;16:179–85.
Atri J, Falshaw M, Gregg R, Robson J, Omar RZ, Dixon S. Improving uptake of breast screening in multiethnic populations: a randomised controlled trial using practice reception staff to contact non-attenders. BMJ. 1997;315:1356–9.
Page A, Morrell S, Tewson R, Taylor R, Brassil A. Mammography screening participation: effects of a media campaign targeting Italian-speaking women. Aust N Z J Public Health. 2005;29:365–71.
Turnbull D, Irwig L, Adelson P. A randomised trial of invitations to attend for screening mammography. Aust J Public Health. 1991;15:33–6.
Powe BD, Faulkenberry R, Harmond L. A review of intervention studies that seek to increase colorectal cancer screening among African-Americans. Am J Health Promot. 2010;25:92–9.
Menon U, Champion V, Monahan PO, Daggy J, Hui S, Skinner CS. Health belief model variables as predictors of progression in stage of mammography adoption. Am J Health Promot. 2007;21:255–61.
Nilchaikovit T, Hill JM, Holland JC. The effects of culture on illness behavior and medical care: Asian and American differences. Gen Hos Psychiatry. 1993;15:41–50.
Gielen AC, McDonald EM. Using the PRECEDE-PROCEED planning model to apply health behavior theories. In: Glanz K, Rimer BK, editors. Lewis FM: health behavior and health education. 3rd ed. San Francisco: Wiley; 2002. p. 409–36.
Campo S, Askelson NM, Routsong T, Graaf LJ, Losch M, Smith H. The green acres effect: the need for a new colorectal cancer screening campaign tailored to rural audiences. Health Educ Behav. 2008;35:749–62.
Cheesman A. Dealing with ethnic and cultural diversity in breast screening. Retrieved on October 10, 2008 from: http://www.camrt.ca/english/newsletter/Oct07/breast_screening.asp.
Canada Health. Quality determinants of organized breast cancer screening programs in Canada. Ottawa: Health Canada; 2003.
Acknowledgments
A version of this paper was awarded the Best Doctoral Paper in 2010 by the Justice Emmett Hall Memorial Foundation. We would like to acknowledge Dr. Sandra L. Bullock and Dr. Paul McDonald for their assistance in developing the topic for this paper, and Ashley Johns, MSc, for her help with editing. Partial work on this paper was supported by a Social Science and Humanities Research Council (SSHRC) Doctoral Award and a University of Waterloo President’s Graduate Scholarship.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schoueri-Mychasiw, N., Campbell, S. & Mai, V. Increasing Screening Mammography Among Immigrant and Minority Women in Canada: A Review of Past Interventions. J Immigrant Minority Health 15, 149–158 (2013). https://doi.org/10.1007/s10903-012-9612-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10903-012-9612-8