Breast Cancer Screening Behavior in Korean Immigrant Women in the United States

Abstract

To address the problem of the underutilization of breast cancer screening in Korean immigrant women in the United States, this study investigates their screening behavior, with a particular emphasis on sociocultural aspects. Breast cancer is the most commonly diagnosed cancer in Korean immigrant women. A regular breast cancer screening is recommended for early detection and timely treatments for breast cancer (Elmore, Armstrong, Lehman, & Fletcher, 2005). Despite its effectiveness of screening, Korean immigrant women are reported to have lower breast cancer screening rates than any other racial/ethnic groups (Lee, Fogg, & Menon, 2008; Lee, Ju, Vang, & Lundquist, 2010). This implies that Korean immigrant women are at risk for being diagnosed with breast cancer at an advanced stage due to their low mammogram receipt resulting in increased mortality. This study uses a cross-sectional, mixed-method study design, in particular a sequential explanatory mixed methods design (Creswell, 2015) to understand breast cancer screening behavior in Korean immigrant women. The Andersen’s Behavioral Model of Health Services Use (Andersen, 1995) along with Health Belief Model (Rosenstock, 1974; Rosenstock et al., 1988) theoretically guided this study. Logistic regression was used to examine facilitators and barriers associated with breast cancer screening in the quantitative phase of the study. In the qualitative phase of the study, semi-structured individual interviews were conducted to explore sociocultural views on breast cancer and breast cancer screening from Korean immigrant women and to obtain further evidence supporting the results of quantitative study. Grounded theory methods (Charmaz, 2006) guided the data collection and analyzed the data results. A total of 240 Korean immigrant women ages between 40 and 79 years old from Los Angeles, California, completed questionnaires and 30 of these participants participated in individual interviews. Approximately 90.1% of study participants completed a mammogram at least once in their lifetime and 62.2% had a mammogram in the past two years. In the past two years, women between 60 - 69 years old had the highest mammogram rate (73.3%) while women between 40 - 49 years old had the lowest mammogram rate (26.3%). With regards to associated facilitators and barriers of screening uptake, the quantitative study identified three facilitators (fatalism, regular check-up and heard about mammogram experiences from family, friends, and neighbors) and a barrier (perceived barriers to screening). Study participants viewed breast cancer as a fearful subject. They reported having different levels and concerns about breast cancer (e.g., fear of getting breast cancer vs feeling safe from breast cancer). The majority of participants strongly believed that breast cancer could be preventable. Interestingly, they had different opinions on ways to prevent breast cancer. The qualitative phase of the study also found five motivations (fear of breast cancer, preventive orientation practice, health insurance, doctors’ recommendation, and family support) and various challenges (e.g., complicated and timing consuming procedure, and language) to breast cancer screening. Results showed that fears of breast cancer boosted Korean immigrant women to adopt preventive health practices while still holding fatalistic attitudes. Fatalistic attitudes are influenced by participants’ own observations of people’s death as a result of being diagnosed with cancer while still maintaining healthy lifestyles and regular check-ups. These observations reinforced fatalistic attitudes on health. Despite having this attitude, the participants wanted to maintain their screening because they believed finding cancer at an earlier stage would be better if it turns out they have cancer. They wanted to avoid having feelings of regret or guilt if they had cancer at advanced stages. Health insurance enabled them to initiate or maintain their regular check-ups, and their primary health care professionals played a role in encouraging them to have a screening. Some participants developed their own strategies (e.g., waiting for to get government funded health insurance and visiting Korea to receive medical examination) to deal with multiple barriers to breast cancer screening. The findings of this mixed methods study helps to obtain a more comprehensive view of Korean immigrant women’s screening behavior and to develop more culturally and individually tailored intervention strategies to promote screening uptake.