Breast Cancer Screening Behavior in Korean Immigrant Women in the United States: Focusing on Cultural Health Beliefs

Background and Purpose: Breast cancer is a common cancer found in Korean immigrant women in the United States. A regular breast cancer screening is recommended for early detection and timely treatments for breast cancer (Elmore et al., 2005). However, Korean immigrant women reported to have lower breast cancer screening rates than any other racial/ethnic groups (Lee et al., 2008; Lee et al., 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. To address the problem of the underutilization of breast cancer screening in Korean immigrant women, this study investigates their screening behavior, in particular the emphasis on sociocultural aspect.

Methods: A cross-sectional survey was conducted with a total of 240 Korean immigrant women ages between 40 and 79 years old residing in Los Angeles, California. The Andersen’s Behavioral Model of Health Services Use (Andersen, 1995) along with Health Belief Model (Rosenstock et al., 1988) theoretically guided this study. Logistic regression was used to examine facilitators and barriers to breast cancer screening.

Results: Approximately 90.1% of study participants completed mammogram at least once in their lifetime and 62.2% have had a mammogram in the past two years. The study participants had various health attitudes and beliefs about breast cancer and breast cancer screening. They had a higher level of fatalistic health attitudes, higher level of preventive health orientation, lower level of perceived susceptibility to breast cancer, higher level of perceived benefits to breast cancer screening, various perceived barriers to breast cancer screening (e.g., radiation exposure), and a higher level of self-efficacy. With regards to associated facilitators and barriers of screening uptake, study participants who had a higher level of fatalistic health attitudes tended to get a mammogram in the past 2 years. Other facilitators of the screening uptake include having regular check-ups and heard about mammogram experiences from family, friends, and neighbors. On the other hand, women who had high levels of perceived barriers to screening were less likely to get a mammogram in the past 2 years.

Conclusion and Implications: The results of this study address interesting points. Study participants had high levels of fatalistic attitudes towards health and preventive health orientation simultaneously, which is unusual because fatalistic health attitudes could contribute to limited preventive health orientation and practices resulting in health disparities (Liang et al., 2004; Niederdeppe, & Levy, 2007). In addition, fatalistic attitudes play a role in facilitating decision about breast cancer screening in this study. It is known that fatalism is linked to low cancer screening rates, delays in cancer treatment after diagnosis, and reluctant to engage in healthy lifestyle practices to reduce cancer risks. People with fatalistic attitudes tend to feel that there is nothing they can do to prevent or avoid cancer (Nelson et al., 2002). More studies, in particular qualitative studies, need to explore Korean immigrant women’s perspectives on breast cancer and breast cancer screening in order to better understand this unique phenomenon.