Breast Cancer Screening Disparity Among Korean Immigrant Women in Midwest: Findings from Andersen's Behavioral Model

Background: Breast cancer is the second leading cause of cancer-related deaths among women in the United States (U.S.) (Miller, King, Joseph, Richardson, & CDC, 2012; Siegel, Naishadham, & Jemal, 2012). Korean immigrant women residing in the U.S. are not exception to the threat of breast cancer. However, Korean immigrant women reported having relatively low breast cancer screening rates compared to other racial/ethnic minority women (Lee et al., 2010; Lee, Fogg, & Sadler, 2006; Lee, Stange, & Ahluwalia, 2014). This implies that Korean immigrant women may be diagnosed with breast cancer at later stages than other women due to their low screening participations, which results in increased mortality. Using three breast cancer screening methods; mammogram, Clinical Breast Examination (CBE), and Breast Self-Examination (BSE), this study aims to investigate breast cancer screening rates and its associated factors to inform future intervention strategies.

Method: A cross-sectional survey was conducted with 168 Korean immigrant women aged 40 and older living in Midwest area. Andersen’s Behavioral Model of Health Services Use (1995) theoretically guided this study and logistic regression was used to examine factors associated with screening receipt and performance.  

Findings: About 71% of the women surveyed have had mammography at least once in their lifetime, whereas 36.3% have had a mammogram in the past three years. Women aged 60 years and over had the highest mammogram rate (60.5%) while women aged 40-49 had the lowest mammogram rate (26.3%) in the past three years. The rate utilizing CBE was much lower than mammography or BSE: 59.5% of the women have utilized CBE at least once in their lifetime, whereas 32.2% had CBE in the past three years. About 76% of study participants have performed BSE at least once in their lifetime, whereas about 68.4% have done BSE in the past three years. With regard to associated factors, knowledge of each screening method was strongly correlated with participants’ use of each method. Other factors associated with the three screening methods were also reported: older age, low barriers to mammogram uptake, and lower educational attainment were positively associated with getting a mammogram; distrust of physicians and higher education level were negatively correlated with CBE receipt, while cancer history of family members was positively correlated with CBE receipt; and health insurance was negatively associated with BSE practice.  

Implications: Study findings suggest overall low rates of recent breast cancer screening receipt and performance. Particularly, the participants’ recent mammogram uptake rate is significantly lower than Healthy People 2020 objective (81.1%). There is an urgent need for education on breast cancer prevention among Korean immigrant women, particularly those with a higher level of barriers and younger age. To promote breast cancer screening in this population, health education should be combined with strategies to increase health care access such as bilingual screening services or assistance of scheduling for screening and transportation.