Breast Cancer Screening Behavior in Korean American Immigrant Women: Underexplored Factors Associated with Mammogram Use

Background and Purpose: There is a high mortality of breast cancer among Korean American immigrant women (KAIW) and regular screening is recommended for early detection and timely treatments. However, KAIW report lower breast cancer screening rates than any other racial/ethnic groups (Lee et al., 2008; Lee et al., 2010).This finding implies that KAIW are at risk of being diagnosed with breast cancer at an advanced stage due to their low mammogram use, resulting in increased mortality. To inform future intervention strategies, this study aimed to (a) describe screening rates in KAIW and (b) examine underexplored factors associated with their screening participation (e.g., free/low-cost mammogram services, fatalism).

Methods: A cross-sectional survey was conducted with a convenience sample of 240 Korean immigrant women ages 40-79 years residing in Los Angeles, California.The survey was self-administered or face-to-face interview in Korean. Completion time was between 40 and 60 minutes. Andersen’s Behavioral Model of Health Services Use (Andersen, 1995) guided this study’s design and analysis. Logistic regression analysis was used to examine underexplored factors associated with mammogram use.

Results: Approximately 90% of the KAIW respondents had a mammogram at some point in their lifetime, and among them 62.2% had a mammogram in the past two years. Analysis by age groups indicated that women ages 60-69 years had the highest mammogram rate (73.3%) in the past two years while women ages 40-49 years had the lowest mammogram rate (49.1%). The strongest correlates of mammogram use within two years were having a regular primary care check-up (OR=5.83, 95% CI 2.33, 14.60) and hearing about a mammogram experience from a family member, friends, or neighbors (OR=4.95, 95% CI 1.47, 16.63). Awareness of free/low-cost mammogram service (OR=2.80, 95% CI 1.40, 5.58) and fatalism (OR=1.14, 95% CI 1.05, 1.25) were also associated with having a mammogram within two years. Interestingly, women who had a higher level of fatalism tended to get screened in the past 2 years than those had a lower level of fatalism.

Conclusion and Implications: Findings pointed to an overall low mammogram screening rate, especially when recent screening experience and age were taken into account. To promote breast cancer screening in the KAIW population, health education efforts should emphasize the importance of having a regular health check-up, include patient stories about the mammogram experience, and provide information about accessing free/low-cost mammogram services. This study also identified the influence of fatalism on mammogram use. It is known that fatalism contributes to a limited preventive health orientation and practice, which results in health disparities (Niederdeppe, & Levy, 2007). However, in this study, a high level of fatalism seemed to facilitate mammogram use. Additional research is needed to understand KAIW’s perspectives on breast cancer and breast cancer screeningin relation to fatalismso that effective and culturally relevant social work and public health interventions can be developed and implemented to increase mammogram use.