Cultural Factors and Breast Cancer Screening Among Older Hispanic Women

Background and Purpose: Breast cancer risk increases with age. In 2012, 41% of breast cancer diagnoses and 58% of breast cancer deaths occurred in women aged 65 and older (Howlader et al., 2014). Older Hispanics will be the largest group of ethnic minority adults in 2050 (National Institute on Aging, 2011). They will experience cancer disparities more than other population groups due in part to their low cancer screening participation. Furthermore, Hispanic women are more likely than Non-Hispanic White women to have late stage breast cancer diagnoses (American Cancer Society, 2012). Psychosocial and cultural factors can influence participation in cancer screenings. Thus, investigations examining cultural factors and cancer screening disparities remain at the forefront of national research initiatives due to the increasing cancer mortality rates of older minority adults. However, many investigations focus on younger and African American populations. Few investigations focus on older Hispanic women. For this reason, this study explored cultural factors influencing older Hispanic women’s participation in breast cancer screening services.

Methods: Guided by constructs of the Social Cognitive and Cultural Dimensions theories, this paper investigates the relationship between cultural factors, time orientation, and uncertainty avoidance of Hispanic women (n = 2,156,564) and their participation in breast cancer screening services. To be included in the sample, participants had to 1) identify as Hispanic; 2) respond to the breast cancer screening question and 3) respond to the time orientation and uncertainty avoidance questions. Time orientation is the extent to which individuals place importance on the future instead of the past and present. Uncertainty avoidance is an individual’s ability to deal with uncertainty and ambiguity (Hofstede, 2001). Data from the 2008 wave of the Health and Retirement Study were used. Multivariate logistic regression models were conducted to identify factors associated with cancer screening participation.

Results: While controlling for demographic and personal factors, results indicate the cultural variables, time orientation, and two measures of uncertainty avoidance predicted older Hispanic women’s participation in breast cancer screening services. For each one point increase towards future time orientation, Hispanic women were 44% less likely to indicate they had not received a mammogram. For each one point increase towards high uncertainty avoidance, Hispanic women were more likely to indicate they had not received a mammogram.

Conclusions and Implications: Findings suggest that providers consider socio-demographic, personal, and cultural factors when assessing older Hispanic women’s participation in breast cancer screening. Providers who understand an older women’s perspective on time and her ability to cope with uncertainty may facilitate decision-making regarding cancer screening participation. Given the social work person-in-environment perspective and psychosocial expertise, social workers are uniquely positioned to work across disciplines to promote these types of patient-centered communications among health care teams and to develop interventions to reduce cancer screening disparities. This role supports the principles of the Affordable Care Act, which promotes prevention and community based treatment. This investigation provides formative data for the development of interventions designed to reduce cancer screening disparities, morbidity, and mortality rates.